Effects of Acute Pain on Motor Learning in Young vs Older Adults

To date, the effects of pain on motor learning have not been thoroughly investigated, particularly in older adults. Broadly, the purpose of this research is to investigate the impact of acute pain on locomotor learning and its retention in older adults. The investigators hypothesize that acute pain impairs retention of locomotor learning in young and older adults and that in older adults, these deficits are worsened and are related to the degree of normal age-related cognitive decline.

Study Overview

• Status: Not yet recruiting
• Conditions: Aging; Pain, Acute; Motor Activity; Cognitive Decline
• Intervention / Treatment: Procedure: pain delivery; Procedure: distractor delivery

• Study Type: Interventional
• Enrollment (Estimated): 102
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ashley Fath; Phone Number: 302-283-9936; Email: fath@udel.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Abbreviations: YA= young adult; OA= older adult; HR= heart rate, bpm= beats per minute; BP= blood pressure; ADD= attention deficit disorder; ADHD= attention deficit hyperactivity disorder; MoCA= Montreal Cognitive Assessment; GAD-7= Generalized Anxiety Disorder 7 Scale; PHQ-2, PHQ-9= Patient Health Questionnaire-2 and -9.

Inclusion Criteria:

1. 18-35 (YA group only) or 55-85 (OA group only) years old
2. Sex-matched to a participant in the OA group (YA group only)
3. Self-identifying as generally medically healthy
4. Able to read, write and speak English
5. Able to provide informed consent and attend all testing sessions
6. Willing to undergo the experimental pain or non-painful electrical stimulation, if selected

Exclusion Criteria:

1. Resting HR < 50 or > 100 bpm
2. Resting BP < 90/60 or > 140/95 mmHg (YA group only) or > 165/95 (OA group only)
3. Any history or current mental health condition, learning/developmental disability or cognitive impairment, including ADD/ADHD, severe anxiety, severe depression, autism spectrum disorder, insomnia, mild cognitive impairment, etc.
4. Score on the MoCA <23
5. Score on the GAD-7 ≥ 10
6. Score on the PHQ-2 ≥ 2 and score on the PHQ-9 ≥ 10
7. Any current (within last 3 month) or chronic medical conditions, including any musculoskeletal, cardiovascular, endocrine, pulmonary, metabolic, psychiatric or neurological diagnosis that (for OA group only) affects activities of daily living or would confound testing or place the subject at risk by participating, such as a significant cardiovascular condition or event (e.g., heart attack < 3 months ago, uncontrolled atrial fibrillation, uncontrolled angina, or congestive heart failure, chronic obstructive pulmonary disorder, peripheral vascular disease)
8. Any implanted electronic medical devices (i.e., cardiac pacemakers, cardiac defibrillators, spinal cord neurostimulators)
9. Any impaired sensation or weakness in either lower extremity or in the area targeted for the stimulus
10. History of serious concussion or head injury, defined as a loss of consciousness for > 5 minutes and/or requiring medical treatment, or > 2 concussions over the lifespan
11. Any history of acute or chronic problems with balance, any dizziness, or > 1 fall in the last 12 months
12. Taking 4 or more medications (YA group only)
13. Currently or regularly using any analgesic medications, over-the-counter remedies, or any other treatment for the purposes of pain relief (i.e., baby aspirin for heart health permitted, etc.)
14. Any current or chronic pain condition during the last year, located anywhere in the body with a (OA group only) pain intensity of > 2/10
15. Allergy to capsaicin or hot peppers
16. Any skin lesion, breakage or irritation in the area targeted for the painful stimulus
17. Skin sensitivity to soaps/creams/perfumes or to heat
18. Poor circulation in the area targeted for the painful stimulus
19. Prior participation in a locomotor learning study in this lab within the last 2 years.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No Stimulus; Nothing applied to skin
Experimental: Pain Stimulus; Capsaicin combined with heat applied to intact skin	Procedure: pain delivery; Experimental pain paradigm delivered that is short-term and painful but not harmful.
Active Comparator: Distractor Somatosensory Stimulus; Sensory transcutaneous electrical nerve stimulation (TENS) applied to intact skin	Procedure: distractor delivery; Distractor stimulus delivered that is short-term and attention-demanding but not painful.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motor Retention Magnitude	degree to which the learned locomotor pattern has been remembered (in step length % change, normalized to the amount learned from day 1)	24 hours post learning (day 2)
Motor Learning Magnitude	degree to which the new locomotor pattern has been acquired (in step length % change)	immediately after learning (day 1)
Digit Span Backward Test	number of digits (numbers) that can be repeated back in the reverse order from which they were presented	the change between baseline and during application of intervention
Digit Span Forward Test	number of digits (numbers) that can be repeated back in the same order as they were presented	the change between baseline and during application of intervention

Collaborators and Investigators

• Sponsor: University of Delaware
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Susanne M Morton, PhD, University of Delaware

Publications and helpful links

General Publications

• Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Available from http://www.ncbi.nlm.nih.gov/books/NBK91497/
• Patel KV, Guralnik JM, Dansie EJ, Turk DC. Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain. 2013 Dec;154(12):2649-2657. doi: 10.1016/j.pain.2013.07.029.
• Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017 Aug 1;177(8):1146-1153. doi: 10.1001/jamainternmed.2017.1622.
• Higgins DM, Martin AM, Baker DG, Vasterling JJ, Risbrough V. The Relationship Between Chronic Pain and Neurocognitive Function: A Systematic Review. Clin J Pain. 2018 Mar;34(3):262-275. doi: 10.1097/AJP.0000000000000536.
• van der Leeuw G, Leveille SG, Dong Z, Shi L, Habtemariam D, Milberg W, Hausdorff JM, Grande L, Gagnon P, McLean RR, Bean JF. Chronic Pain and Attention in Older Community-Dwelling Adults. J Am Geriatr Soc. 2018 Jul;66(7):1318-1324. doi: 10.1111/jgs.15413. Epub 2018 Jun 6.

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2024
• Primary Completion (Estimated): March 15, 2025
• Study Completion (Estimated): March 30, 2025

Study Registration Dates

• First Submitted: July 17, 2022
• First Submitted That Met QC Criteria: July 20, 2022
• First Posted (Actual): July 25, 2022

Study Record Updates

• Last Update Posted (Actual): April 3, 2024
• Last Update Submitted That Met QC Criteria: April 2, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Elderly; Pain; Gait; Adults; Older Adults; Memory; Cognition; Walking; Motor learning; Acute pain; Learning; Young adults; Locomotion; Cognitive ability; Motor Consolidation
• Additional Relevant MeSH Terms: Mental Disorders; Pain; Neurologic Manifestations; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction; Acute Pain
• Other Study ID Numbers: 1786370-1.1; R01AG071585 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No