Pain Assessment in Impaired Cognition

Dear Colleagues,

Assessing pain in individuals with cognitive impairment is a major challenge. Cognitive impairment reduces reliability of subjective pain reports, the gold standard for assessing pain. As a result, there has been an upsurge in the use of observational scales for pain assessment purposes in cognitive impairment. Whereas these observations are in general more reliable compared to subjective reports of pain, we still know very little of how different underlying pathologies and cognitive changes may, or may not, influence pain assessed via these methods. Specifically, clinical conditions differ immensely with regard to their cognitive deficits; it remains yet to be clarified how these different profiles influence behavioural responses to pain, pain observations and subjective reports. Moreover, whereas cognitive decline has in general been associated with a decline in clinical pain being reported, preliminary work on pathological brain changes in aging and dementia shows a different line of results. Here, more brain white matter atrophy has been related to an increase in clinical pain report, despite the cognitive loss that is also associated with higher atrophy levels. This illustrates the complexity of assessing pain in patients with cognitive impairment.

The aim of this Special Issue is to provide further insight into how cognitive impairment and underlying neuropathological changes influence (findings from) pain assessment in patients with cognitive impairment. Ultimately, its aim is to further understand how pain assessment can be improved in different clinical conditions.

We are soliciting original experimental and observational studies addressing pain assessment in relation to cognitive impairment/clinical diagnosis/neuropathology. Research focussing on pain processing and pain assessment in individuals with different types of cognitive impairments by use of various pain assessment methods and by also considering underlying mechanisms such as brain pathology and neuropsychological profile is especially welcome.

Dr. Joukje M. Oosterman
Prof. Miriam Kunz
Guest Editors

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