Exploring the relationship between pain, cognition, and chronic conditions: insights from the HAALSI study in rural South Africa

Research on cognition and pain is limited in Low and Middle-income Countries (LMICs) and understanding how chronic conditions and pain treatment may moderate this association is underexplored. This study aimed to explore the relationship between pain and cognition and the moderating effect of hypertension, diabetes, HIV, pain treatment, and depressive symptoms.

We analyzed data from 3803 individuals enrolled in the HAALSI study, a longitudinal population study of older adults in Agincourt, South Africa. Pain was measured with the Brief Pain Inventory. Cognition was assessed using a composite of orientation questions, a memory test, and the Trails Making Test B. Chronic conditions were assessed using biological measures, and depressive symptoms were measured using the CES-D scale. Linear regression models were used to investigate the relationship.

Baseline and longitudinal pain were significantly associated with poorer episodic memory (ß = -0.17 [P < .001]; ß = -0.18 [P < .001]). Hypertension amplified the negative effect of pain on episodic memory, while diabetes and HIV did not moderate the relationship between pain and cognition (ß = -0.10 [.006]). Pain treatment was associated with poorer cognitive performance. Depressive symptoms moderated the relationship between pain and both cognition and executive function (EF) (P = .02). The negative effect of pain on episodic memory was observed in individuals with both acute and persisting pain, while it only affected EF in those with acute pain.

These findings highlight the importance of examining factors that may moderate the relationship between pain and cognition and strategies to mitigate the effect pain has on cognition, particularly in LMICs.