We know that people who are having their pain management reduced or eliminated entirely, their QOL deteriorates dramatically, often the person becomes disabled, losing their job(s) or the business that they have owed and operated for years. Often the “healthy spouse” abandons/divorces the chronic pain spouse. Even if the “healthy spouse” stays, the family’s financial issues can be severely compromised, because of the cost of the medical care of the chronic pain spouse.
Within the article below it is stated what can contribute to dementia: “The Lancet Commission summarized the latest evidence, including the value of controlling vascular risk factors like blood pressure, obesity, diabetes, and smoking; optimizing exercise and sleep; and countering social isolation and depression. In later ages, addressing hearing and vision limitation is important, as is preventing falls and head injuries.”
How many of those risk factors can be attributed to a chronic pain pt that loses their pain management meds? Medical practitioners are suppose to be “healers”.
Maybe Pam Bondi or whoever is the new Federal Attorney General can be encouraged to look at the physical & mental damages the actions of the DEA/DOJ is doing to an estimated 100+ million chronic pain pts, including an estimated 15 million kids (<19 y/o) suffering from chronic pain.
Most of us know that in 1965 – before the CSA was signed into law – there is a law:
https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)
§1395. Prohibition against any Federal interference
Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
I asked perplexity.ai: could under/untreated pain cause an increase in dementia?
Yes, under/untreated pain could potentially cause an increase in dementia risk and exacerbate symptoms in those already diagnosed with dementia. Several studies have found significant associations between chronic pain and cognitive decline:
1. Chronic pain lasting over three months raises the risk of cognitive decline and dementia[1]. In a 60-year-old person with one site of chronic pain, the hippocampus (crucial for learning and memory) aged by about a year compared to those without pain[1].
2. Untreated pain in dementia patients can lead to observable neuropsychiatric symptoms like depression, agitation, and restlessness, which were previously thought to be solely due to neurodegeneration[2].
3. A large cohort study found that chronic pain was associated with a higher risk of dementia, especially in the 50-64 age group[3]. The increased risk persisted even after 5 years of follow-up[3].
4. Chronic pain may contribute to dementia risk through several mechanisms:
– Disruption of attention and memory processes[3]
– Impairment of decision-making and processing speed[3]
– Increased production of endogenous cortisol, potentially leading to hippocampal degeneration[3]
– Chronic inflammation, which may affect brain connectivity and function[1]
5. Untreated pain in dementia patients can lead to reduced quality of life, poor sleep patterns, impaired social interactions, and aggressive behaviors[5]. These factors may further contribute to cognitive decline.
6. Research suggests that in individuals with chronic pain, cognitive decline is likely to progress more rapidly[8].
Given these findings, proper pain assessment and management are crucial, especially in older adults and those with dementia, to potentially reduce the risk of cognitive decline and improve quality of life.
Citations:
[1] https://edition.cnn.com/2023/02/20/health/dementia-chronic-pain-wellness/index.html
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC8543251/
[3] https://www.painphysicianjournal.com/current/pdf?article=NzMyOA%3D%3D&journal=138
[4] https://aaic.alz.org/releases_2023/opioids-increase-risk-death-older-adults-dementia.asp
[5] https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.592366/full
[6] https://www.jpain.org/article/S1526-5900(07)00601-3/fulltext
[7] https://pubmed.ncbi.nlm.nih.gov/34089652/
[8] https://www.verywellhealth.com/top-tips-on-causes-and-signs-of-un-treated-pain-in-dementia-3573193
Dementia Cases to Double in the U.S.
https://www.medpagetoday.com/neurology/dementia/113756
1 million adults projected to develop dementia each year by 2060
Key Takeaways
- U.S. dementia cases were projected to reach 1 million annually by 2060, doubling from 514,000 cases in 2020.
- Lifetime dementia risk was estimated at 42%, with incidence increasing after age 75.
- Projected rates were highest in Black adults, women, and APOE4 carriers.
Dementia cases in the U.S. are expected to double in the next four decades, a new analysis suggested.
In a racially and geographically diverse sample, the lifetime risk of dementia was estimated at 42% (95% CI 41-43) with incidence increasing substantially after age 75, according to Josef Coresh, MD, PhD, of New York University Grossman School of Medicine in New York City, and co-authors.
Based on U.S. Census data, the number of adults who will develop dementia each year was projected to increase from about 514,000 in 2020 to 1 million in 2060, Coresh and colleagues reported in Nature Medicine
Projected rates were highest in Black adults, women, and APOE4 carriers, with lifetime risks ranging from 44% to 59% in these groups. Mortality was treated as a competing event.
“It’s important to note that the risk from ages 55 to 75 is 4%,” Coresh told MedPage Today. “It rises to 20% by age 85 and then 42% by age 95, so half the risk is after age 85.”
The lifetime risk figures are considerably higher than previous estimates. Data from the Framingham Heart Study data suggested, for example, that about 14% of men and 23% of women in the U.S. would develop dementia during their lives.
The new estimates came from a more diverse group of people followed from 1987 to 2020, using an extensive range of methods to ascertain dementia, Coresh pointed out. It relied on data from the Atherosclerosis Risk in Communities (ARIC cohort, which was more diverse geographically, racially, and socioeconomically than other studies, he added.
The analysis extends existing research by quantifying the growth of incident dementia, incorporating trends that likely will be driven by the Baby Boom generation reaching older ages, the researchers said. The findings highlight the importance of strategies to reduce dementia risk and address racial inequities in healthcare, they added.
“We now know that half of dementia risk is preventable,” Coresh said. “The Lancet Commission summarized the latest evidence, including the value of controlling vascular risk factors like blood pressure, obesity, diabetes, and smoking; optimizing exercise and sleep; and countering social isolation and depression. In later ages, addressing hearing and vision limitation is important, as is preventing falls and head injuries.”
In the U.S. and globally, there’s an urgent need to address the crisis of Alzheimer’s disease and dementia, noted Maria Carrillo, PhD, chief science officer and medical affairs lead for the Alzheimer’s Association in Chicago, which wasn’t involved with the study.
“In the coming years, more people will be affected,” Carrillo said. “This is especially true for high-risk groups who often have been underrepresented in research, including Black Americans, Hispanic Americans, and women.”
The ongoing POINTER trialis evaluating whether lifestyle interventions that simultaneously target several risk factors can protect cognitive function in people at increased risk for cognitive decline, she added.
Coresh and colleagues evaluated health records from 15,043 participants in the community-based, prospective ARIC cohort in North Carolina, Mississippi, Minnesota, and Maryland who were 55 and older. All were dementia-free at age 55.
The sample included 55.1% women and 26.9% Black participants. About a third (30.8%) of participants had at least one APOE4 allele.
Over a median follow-up of 23 years, there were 3,252 incident cases of dementia. Of the dementia cases, 49% were diagnosed through phone interviews, 27% through hospital and death record review, and 24% at study visits with cognitive testing.
Differences in risk across race emerged at about age 75, while sex differences emerged at about age 85. Lifetime risks were 41% in white versus 44% in Black participants, and 35% in men versus 48% in women, due perhaps to women’s higher life expectancy.
People with two APOE4 copies had a higher lifetime risk of dementia (59%) than those with one copy (48%) or no copies (39%), with differences starting at around age 70.
The analysis had several limitations, the researchers acknowledged. Some dementia cases may have been misclassified, and some cases might not have been captured. The study also was not externally validated.
“Future population-based studies with long follow-up and comprehensive dementia ascertainment are needed to validate our lifetime risk estimates,” they wrote.
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The Purdue settlement suffered a setback in July but appears still a work in progress. In the opioid crisis, it seems “victory,” even if a bit pyrrhic is at hand. 
