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


OBJECTIVE
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.
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.
Department of Psychology, Division of Medical-Clinical Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA.
Cady
C
Block
Leanne
L
Cianfrini
D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology*; D059350:Chronic Pain / Q000188:drug therapy* / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests
D000701:Analgesics, Opioid
Pain; analgesics; automobile driving; chronic; cognition; neuropsychology; opioid