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Purpose: The purpose of this study was to examine the association of pain intensity and fear of pain with executive function in community-dwelling older adults with chronic pain. Methods: The community-dwelling older adults with chronic pain (pain duration≥ 3 months) were recruited. People whose Mini-Mental State Examination (MMSE) score was less than 24 point were excluded. Executive functionwas assessed by Digit Symbol Substitution Test (DSST). Subjective pain intensity was assessed by Numeric Rating Scale (NRS). Fear of pain was assessed by Tampa Scale for Kinesiophobia (TSK). Depression was measured using Geriatric Depression Scale (GDS). Pearson correlation test, Spearman rank correlation test and multiple regression analysis were used. In multiple regression analysis, DSST was taken as the main explanatory variable, whereas NRS/TSK was the outcome variable. Age, sex, years of education, the number of medication use, analgesic medication, MMSE, GDS and TSK/NRS were included as confounding factors. Results:Participantswere 105 community-dwelling older adults (78 women, mean age: 74.0± 6.6 years). In univariate analysis, DSST was associated with NRS and TSK significantly (NRS;ρ =−0.27, p< 0.001, TSK; r=−0.24, p< 0.05). In multivariate analysis, after adjustment, NRS and TSK was still associated with DSST (NRS; adjusted β =−0.30, p< 0.05, adjusted R2 = 0.16, TSK; adjusted β =−0.25, p< 0.05, adjusted R2 = 0.26). Conclusion(s): Pain intensity and fear of pain was associated with executive function in community-dwelling older adults with chronic pain. Implications: In order to reduce pain intensity or to improve fear of pain in community dwelling older adults with chronic pain, it would be efficacious to approach to executive function.

Methods: Twenty acute stroke patients were randomized into rTMS group or sham group. Patients received 5 daily sessions of 1Hz rTMS or sham rTMS over the intact motor cortex. For recording MRCP, patients performed self-paced wrist dorsiflexion of affected limb before and after rTMS sessions. Electrodes were placed at Fz, FC3, FCz, FC4, C3, Cz, C4 and Pz according to the international 10–20 system. MRCPwas divided into 3 components of Bereitschaft potential (BP), negative slope (NS’) and motor potential (MP). For behavioral testing, patients performed the upper extremity Fugl-Meyer Assessment (FMA), pegboard test, and grip strength before and after rTMS sessions. TheMRCP data and behavioral data were subjected to repeated measures analysis of variance (ANOVA) using time (pre-rTMS and post-rTMS) as within-subject factors and group (rTMS group and sham group) as a between-subject factor. Pearson correlation coefficient or Spearman’s rank correlation coefficient was used to assess associations between MRCP and motor function data. Results: MRCP showed a significant increase of MP amplitude at C and FC sites in affected hemisphere after rTMS to the contralesional motor cortex for five days (Ps < 0.05). At the same time, there were increases of NS’ amplitude at C and FC sites in affected hemisphere and at Cz site (Ps < 0.05). The behavioral data showed significant improvement of FMA and PPT in the rTMS group compared to the sham group (Ps < 0.02). The improvement of FMA for upper limbmotor functionwas correlatedwith the increase of MRCPamplitude recorded over the ipsilesionalmotor cortex. Conclusion(s): Low-frequency rTMS to contralesional motor cortex promoted motor functional recovery of upper extremity for acute stroke patients, and this improvement was associated with enhanced movement-related electrophysiological activity of affected motor cortex possibly through suppression of transcallosal inhibition. Implications: Low-frequency rTMS to non-affected hemisphere may be promising intervention for motor recovery even in acute stroke patients with hemiparesis.