Submitted Abstract
A disproportionate number of older adults are suffering from acute or chronic pain. Pain in elderly is often under-diagnosed and under-treated, leading to adverse health outcomes. In our aging society, this means a big burden in terms of health care costs. Pharmacological therapies are less suitable for elderly due to decreased kidney and liver function and increased adverse effects related to co-morbidities and drug interactions. Elderly could thus benefit greatly from additional non-pharmacological approaches. Surprisingly little research, however, has focused on how aging affects pain perception and treatment. Almost nothing is known about how pain is processed in the brains of aging individuals, even though age-related brain atrophy is particularly apparent in regions that are known to be involved in pain perception, such as the prefrontal cortex, insula and somatosensory cortex. Pain treatment studies have almost exclusively been conducted in young adults. Moreover, the impact and efficacy of psychological interventions in the older population remains largely unexplored. Pain in the elderly is thus a serious issue in society, which urgently needs attention. The development of more effective pain management strategies, specifically targeted at the special needs of older persons in our community, first requires a much better understanding of how pain is processed and modulated in this age group. The primary objective of this project is to investigate the effects of aging on cerebral processing of pain and on psychological pain modulation. We will use two different functional neuroimaging techniques (high spatial resolution magnetic resonance imaging (fMRI) and high temporal resolution electroencephalography (EEG)) to compare how pain is processed and modulated in young and older adults. In particular, we will study the behavioural and neural effects of distraction from pain and of placebo treatment; two important analgesic mechanisms relying strongly on cognitive resources. To date, neither mechanism has been systematically investigated in older adults. We will hereby particularly focus on the role of age-related prefrontal lobe atrophy in altering the impact of these cognitive pain modulators. Understanding the role of these cognitive influences on pain perception in elderly would have a direct impact on our ability to harness positive and minimise negative effects therapeutically, as well as optimise clinical trial designs when developing new analgesics.