Pain Sensitivity and Unpleasantness in People with Alzheimer's Disease and Cancer

项目摘要 此多站点（范德比尔特大学医学中心[VUMC]和俄亥俄州州立大学[OSU]）R01应用程序 是为了回应PA-18 - 502-推进老年姑息治疗科学。这项建议 研究4期乳腺癌和前列腺癌对疼痛敏感性的心理物理测量的影响， 阿尔茨海默病（AD）的不愉快。相当多的老年人会患上癌症， 同时发生的AD使他们在接受治疗的癌症疼痛下遭受痛苦的风险很大。了解影响 癌症和AD对疼痛感知的影响将为AD中的癌症疼痛提供关键见解。可惜 未经治疗的癌症疼痛的后果可能是毁灭性的。超过50%的癌症住院患者 将他们的痛苦描述为"痛苦、可怕或折磨人"。癌症和老年痴呆症 疾病改变疼痛处理。改变的疼痛处理可能会进一步增加疼痛检测减少的风险 在受伤时，增加转移性癌症疼痛治疗不足的风险，并可能倾向于增加 痛苦如果我们的结果确定癌症和同时发生的阿尔茨海默病将这些人置于 风险增加的痛苦，有针对性的镇痛药物开发策略，和/或量身定制的干预措施， 然后，可以为这个高度脆弱和研究不足的人群设计最大限度的疼痛治疗。 我们将研究热和压力疼痛阈值以及中枢致敏（通过颞叶神经元评估）。 在每个部位按组平衡的132人中（总计n = 264）：132名男性（44名4期 前列腺癌，44例AD和4期前列腺癌，44例仅AD）和132例女性（44例4期 4例乳腺癌，44例AD和4期乳腺癌，44例仅AD）。我们的总体假设是 与仅患有AD的老年人相比，患有4期乳腺癌和前列腺癌疼痛的老年人 中枢神经系统敏感，并有经历强烈的日常癌症疼痛的风险，而在那些患有共病AD，脑 损伤导致中枢神经系统疼痛处理的进一步改变， 准确地自我报告疼痛，增加了癌症疼痛治疗的风险，并可能倾向于增加 生命尽头的痛苦。 我们设计了拟议的研究，以尽量减少参与研究的负担，使受试者 包括收集所有研究数据，无论参与者 居住地，如家庭、辅助生活或疗养院。总结一下， 检查癌症和共同发生的阿尔茨海默病对疼痛感知的影响， 在这个人群中进行疼痛的对照实验研究。这项拟议中的研究是第一次测试疼痛阈值 和感知的能力。结果可能会立即帮助指导疼痛护理在这个高度 老年人的弱势群体。

PROJECT SUMMARY This multi-site (Vanderbilt University Medical Center [VUMC] and Ohio State University [OSU]) R01 application is submitted in response to PA-18-502--Advancing the Science of Geriatric Palliative Care. This proposal examines the impact of stage 4 breast and prostate cancer on psychophysical measures of pain sensitivity and unpleasantness in Alzheimer's disease (AD). A considerable number of older adults will suffer from cancer and co-occurring AD placing them at great risk of suffering under treated cancer pain. Understanding the impact of cancer and AD on pain perception will provide key insights into cancer pain in AD. Unfortunately, the consequences of untreated cancer pain can be devastating. More than 50% of hospitalized patients with cancer described their pain as `distressing, horrible, or excruciating'. It remains unknown how cancer and Alzheimer's disease alter pain processing. Altered pain processing may further increase the risk for reduced detection of pain upon injury, increase the risk for under treatment of metastatic cancer pain, and may predispose to increased suffering. If our results determine that cancer and co- occurring Alzheimer's disease place these individuals at risk of increased suffering, targeted analgesic drug development strategies, and/or tailored interventions to maximize pain treatment can then be designed for this highly vulnerable and under studied population. We will study thermal and pressure pain thresholds as well as central sensitization (assessed via temporal summation) to pain in 132 people balanced by group at each site (total n=264):132 males (44 with stage 4 prostate cancer, 44 with AD and stage 4 prostate cancer, and 44 with AD only) and 132 females (44 with stage 4 breast cancer, 44 with AD and stage 4 breast cancer, and 44 with AD only). Our overall hypothesis is that when compared to older adults with AD only, older adults with stage 4 breast and prostate cancer pain develop CNS sensitization and are at risk of experiencing intense daily cancer pain, and in those with comorbid AD, brain damage leads to further alterations in CNS pain processing which decreases the ability to recognize and accurately self-report pain, increases the risk of under treatment of cancer pain, and may predispose to increased suffering at the end of life. We have designed the proposed study to minimize the burden of participating in research to make the subjects and their caregivers as comfortable as possible including collecting all study data wherever the participant resides such as home, assisted living, or nursing homes. To summarize, there are extremely few studies examining the impact of cancer and co-occurring Alzheimer's disease on pain perception and there are no controlled experimental studies of pain in this population. The proposed study is the first to test pain threshold and perception in this under-studied population. Results may immediately help guide pain care in this highly vulnerable group of older adults.