425: Baseline Characteristics of Older Adults with Chronic Pain and Early Cognitive Decline

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Digital Health Technologies , Pain in Special Populations , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Chronic pain (CP) and early cognitive decline (ECD) frequently co-occur in older adults and exacerbate physical, emotional, and cognitive impairment, increasing risk for Alzheimer’s disease and related dementias. Evidence indicates a bidirectional relationship, whereby chronic pain accelerates cognitive decline, and cognitive impairment amplifies pain, maladaptive responses, and functional limitation. Despite these risks, empirical data describing older adults with CP and ECD who enroll in behavioral trials remain limited. Poor characterization constrains recruitment, intervention tailoring, and interpretation of treatment outcomes. This study describes baseline demographic, clinical, and psychosocial characteristics of this vulnerable population to inform future behavioral interventions and clinical trials.

Methods: Baseline data were analyzed from an ongoing single-blind, parallel-arm efficacy trial (N = 267) comparing a group-based mind-body walking intervention (Active Brains) with a time- and attention-matched education control (Health Enhancement Program) conducted online across the United States. Participants were older adults with heterogeneous chronic pain (3+ months) and early cognitive decline (subjective concerns or mild cognitive impairment). Descriptive statistics summarized demographics, medical history, cognitive function, physical performance, emotional and social functioning, pain-related cognitions, and coping skills. Measures included patient-reported outcomes and objective assessments, including standardized neuropsychological testing, the 6-minute walk test, and ActiGraph-derived daily step counts.

Results: Participants(68.46years) were predominantly White(78.3%) women(74.2%) with longstanding (45.3% ≥10years), multisite CP. Pain intensity (NRS =5.51) and interference (PROMIS=63.00) were moderate. Cognition showed mild impairment (RBANS=93.04) with subjective decline(eCOG=2.09). Physical function was low (PROMIS=38.35; 6-minute-walk=369.75) with steps (1,823). High psychosocial risks included anxiety (PROMIS =54.92), depression (PROMIS=54.09), loneliness (PROMIS=59.63), pain catastrophizing (PCS=16.77), kinesiophobia (TSK=38.79), low pain self-efficacy (PSEQ=35.85), and moderate use of coping (MOCS=27.76), self-compassion (SCS=38.14), mindfulness (Toronto=24.99), and gratitude (GQ8=34.73) skills.

Conclusions: Baseline profiles revealed low physical, cognitive, emotional, and social functioning, consistent with an interrelated disability spiral in older adults with comorbid CP and ECD. Findings highlight the need for multicomponent behavioral interventions that integrate pain management, physical activity promotion, and skills-based coping. Key intervention targets include enhancing pain self-efficacy, reducing catastrophizing and kinesiophobia, and strengthening adaptive coping through mindfulness and mind-body strategies. These baseline data provide essential context for interpreting post-intervention and 6-month follow-up effects on co-primary physical function outcomes and secondary cognitive and emotional outcomes, and for identifying mechanisms whereby behavioral interventions may mitigate dementia risk and disability.

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Presenting Author: Ryan Mace
Submitting Author: Defne Yucebas

Senior Author: Ana-Maria Vranceanu

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Ryan Mace: Ph.D. - Massachusetts General Brigham
• Christopher Webster: Ph.D. - Massachusetts General Brigham
• Defne Yucebas: BA - Massachusetts General Brigham
• Morgan Seward: BA - Massachusetts General Brigham
• Christine Ritchie: MD, MSPH - Massachusetts General Brigham
• Ana-Maria Vranceanu: Ph.D. - Massachusetts General Brigham