Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia

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BACKGROUND: The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. OBJECTIVES: To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. METHODS: This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases. DISCUSSION AND SUMMARY/CONCLUSIONS: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations. © 2013 - IOS Press and the authors. All rights reserved.

Author-supplied keywords

  • *analgesia
  • *chronic pain/dt [Drug Therapy]
  • *cognitive defect/si [Side Effect]
  • *neuroanatomy
  • *neuropsychology
  • *opiate/ae [Adverse Drug Reaction]
  • *opiate/do [Drug Dose]
  • *opiate/dt [Drug Therapy]
  • *opiate/pd [Pharmacology]
  • *opiate/pk [Pharmacokinetics]
  • *opiate/po [Oral Drug Administration]
  • alcohol blood level
  • amygdaloid nucleus
  • anterior cingulate
  • apoptosis
  • article
  • attention
  • backache
  • benzodiazepine derivative/ae [Adverse Drug Reactio
  • brain blood flow
  • brain cortex
  • brain depth stimulation
  • buprenorphine/ae [Adverse Drug Reaction]
  • buprenorphine/dt [Drug Therapy]
  • buprenorphine/td [Transdermal Drug Administration]
  • cancer pain/dt [Drug Therapy]
  • chronic fatigue syndrome
  • cingulate gyrus
  • clinical decision making
  • codeine/ae [Adverse Drug Reaction]
  • cognitive rehabilitation
  • constipation/si [Side Effect]
  • corticotropin releasing factor receptor 1/ec [Endo
  • depression/si [Side Effect]
  • dextropropoxyphene/ae [Adverse Drug Reaction]
  • dizziness/si [Side Effect]
  • driving ability
  • drowsiness/si [Side Effect]
  • drug blood level
  • drug dose increase
  • drug safety
  • drug screening
  • emotion
  • epilepsy/th [Therapy]
  • executive function
  • fatigue/si [Side Effect]
  • fentanyl/ct [Clinical Trial]
  • fentanyl/dt [Drug Therapy]
  • functional magnetic resonance imaging
  • hallucination/si [Side Effect]
  • hip pain
  • hippocampus
  • human
  • hydromorphone/dt [Drug Therapy]
  • inferior frontal gyrus
  • insula
  • irritable colon
  • ketobemidone/dt [Drug Therapy]
  • levorphanol/dt [Drug Therapy]
  • levorphanol/po [Oral Drug Administration]
  • lifestyle modification
  • low back pain/dt [Drug Therapy]
  • memory disorder/si [Side Effect]
  • meta analysis (topic)
  • methadone/dt [Drug Therapy]
  • morphine/ae [Adverse Drug Reaction]
  • morphine/cr [Drug Concentration]
  • morphine/dt [Drug Therapy]
  • morphine/po [Oral Drug Administration]
  • motor control
  • motor performance
  • nerve cell plasticity
  • neurobiology
  • neurochemistry
  • neuroimaging
  • neuropsychological test
  • nonhuman
  • opiate addiction
  • oxycodone/ct [Clinical Trial]
  • oxycodone/dt [Drug Therapy]
  • oxycodone/iv [Intravenous Drug Administration]
  • pain assessment
  • parietal cortex
  • patient education
  • pethidine/ae [Adverse Drug Reaction]
  • positron emission tomography
  • posterior cingulate
  • prefrontal cortex
  • problem solving
  • psychomotor development
  • quality of life
  • randomized controlled trial (topic)
  • relaxation training
  • remifentanil/dt [Drug Therapy]
  • return to work
  • sedation
  • sex difference
  • side effect/si [Side Effect]
  • single drug dose
  • somatosensory cortex
  • systematic review (topic)
  • terminal care
  • thalamus
  • verbal memory
  • visual memory
  • working memory

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