Beyond pain presence: the impact of multisite pain and pain interference on cognitive functioning among middle-aged and older adults

Objectives This study investigates the relationship between chronic pain and cognitive function in the U.S. middle-aged and older population, focusing on the impact of the number of pain sites. It also explores whether pain interference mediates the association between pain sites and cognition. Methods Data were drawn from the 2004–2006 and 2013–2017 waves of the Midlife in the United States Study (MIDUS 2 and MIDUS 3, N=2,219). We fit inverse-probability-weighted models to examine the associations between pain status, number of pain sites (none vs. 1–2 vs. 3+ sites), and cognitive function in MIDUS 3, controlling for confounders from MIDUS 2. The Sobel–Goodman mediation test with Bonferroni-adjusted significance level was applied to assess the mediating role of pain interference in five domains: activities, mood, relationships, sleep, and enjoyment. Results Among those with chronic pain, 40% report pain in three or more sites. There was no significant difference in cognitive function between individuals with and without chronic pain. However, individuals with pain in 3+ sites had significantly poorer cognitive function than those with no pain or pain in 1–2 sites. Pain interference significantly mediated over 50% of this association, with social relations being the strongest mediator, followed by mood. Discussion The mere presence of chronic pain may not significantly affect cognitive function, but having multi-site pain could be a risk factor for cognitive decline in later life. Addressing multi-site pain and/or pain interference in psychosocial dimensions may help protect cognitive health.