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    Contact heat sensitivity and reports of unpleasantness in communicative people with mild to moderate cognitive impairment in Alzheimer's disease: a cross-sectional study.

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    Author
    Monroe, TB; Gibson, SJ; Bruehl, SP; Gore, JC; Dietrich, MS; Newhouse, P; Atalla, S; Cowan, RL
    Date
    2016-05-10
    Source Title
    BMC Medicine
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Gibson, Stephen
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Monroe, T. B., Gibson, S. J., Bruehl, S. P., Gore, J. C., Dietrich, M. S., Newhouse, P., Atalla, S. & Cowan, R. L. (2016). Contact heat sensitivity and reports of unpleasantness in communicative people with mild to moderate cognitive impairment in Alzheimer's disease: a cross-sectional study.. BMC Med, 14 (1), pp.74-. https://doi.org/10.1186/s12916-016-0619-1.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257995
    DOI
    10.1186/s12916-016-0619-1
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863331
    Abstract
    BACKGROUND: Compared to healthy controls, people with Alzheimer's disease (AD) have been shown to receive less pain medication and report pain less frequently. It is unknown if these findings reflect less perceived pain in AD, an inability to recognize pain, or an inability to communicate pain. METHODS: To further examine aspects of pain processing in AD, we conducted a cross-sectional study of sex-matched adults ≥65 years old with and without AD (AD: n = 40, female = 20, median age = 75; control: n = 40, female = 20, median age = 70) to compare the psychophysical response to contact-evoked perceptual heat thresholds of warmth, mild pain, and moderate pain, and self-reported unpleasantness for each percept. RESULTS: When compared to controls, participants with AD required higher temperatures to report sensing warmth (Cohen's d = 0.64, p = 0.002), mild pain (Cohen's d = 0.51, p = 0.016), and moderate pain (Cohen's d = 0.45, p = 0.043). Conversely, there were no significant between-group differences in unpleasantness ratings (p > 0.05). CONCLUSIONS: The between-group findings demonstrate that when compared to controls, people with AD are less sensitive to the detection of thermal pain but do not differ in affective response to the unpleasant aspects of thermal pain. These findings suggest that people with AD may experience greater levels of pain and potentially greater levels of tissue or organ damage prior to identifying and reporting injury. This finding may help to explain the decreased frequency of pain reports and consequently a lower administration of analgesics in AD.

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