After‐effects of cognitive control on pain

Abstract

Background: The higher order processes involved in self-regulation are generally thought to depend on cognitive (attentional/executive) functions with limited resources. Experimental studies further show that exerting self-control in a first task results in decreased performance in other following self-control tasks, which may be interpreted as the consequence of either effective or perceived resource depletion outlasting the first task. Given that higher order cognitive/attentional processes are also considered to be involved in pain modulatory mechanisms, we tested the idea that pain could be influenced by prior mobilization of cognitive resources. Methods: The present study investigated the consequences of performing a cognitively demanding task on subsequent pain (ratings) and spinal nociceptive responses (nociceptive flexion reflex, NFR) elicited by noxious electrical stimulations in healthy volunteers. Participants received four noxious stimulations immediately after each of six successive blocks (2 min each) of a numerical Stroop task in a neutral condition (low cognitive demand) and six successive blocks in an interference condition (high cognitive demand). Results: Results revealed that pain was rated higher following the condition requiring higher cognitive control. A similar effect was observed on the NFR. Conclusions: These findings suggest that pain regulation mechanisms including the descending pain modulatory system may be less efficient after the performance of tasks requiring high cognitive control resulting in stronger pain experience.

Delayed effects of attention on pain sensitivity and conditioned pain modulation

“…In accordance with the hypothesis, the results show that VAS scores were lower during Stroop sessions compared to sessions with stimulus-evoked pain without Stroop and with no differences between Stroop-pain and Stroop-pain-conditioning. These results support top-down analgesia possibly derived via cortical and/or subcortical regions (Damien, Colloca, Bellei-Rodriguez, & Marchand, 2018;Wiech, 2016), and align with the existing literature showing that Stroop is sufficient to reduce pain sensitivity in healthy participants (Bantick et al, 2002;Fechir et al, 2009;Martinsen et al, 2014Martinsen et al, , 2018Oosterman et al, 2010;Wilder-Smith et al, 2013) although one study found increased pain with increased cognitive load (Silvestrini & Rainville, 2013) and no significant difference in pain sensitivity was found in another study (Aniskin et al, 2011). Of previous studies only three looked at differences between congruent and incongruent paradigms with regards to pain sensitivity (Bantick et al, 2002;Martinsen et al, 2014Martinsen et al, , 2018 and a difference was only found in one of the three (Bantick et al, 2002).…”

“…Pain inhibition during distraction and CPM are not the same (Lautenbacher, Prager, & Rollman, 2007;Moont, Crispel, Lev, Pud, & Yarnitsky, 2012;Moont et al, 2010). In support of this, CPM effects do not diminish when repeated over 20 minutes (Hoegh, Petersen, & Graven-Nielsen, 2018) while attention-induced analgesia does (Silvestrini & Rainville, 2013). However, some authors suggest that CPM and attention could depend on the capacity of the same descending control systems (MacLeod, 1992;Silvestrini & Rainville, 2013;Stroop, 1935).…”

Thinking of anything else does not always reduce pain: It depends on timing

“…Therefore, there was not a direct pain measurement, nor an objective evidence of the level of the nociceptive sensitization. Silvestrini and Rainville (), beyond showing an increased subjective pain perception after a highly demanding cognitive task, demonstrated that the sensitization to the painful stimuli begins from the nociceptive input processing at the spinal cord level (increased NFR score). This last finding means that the increased pain perception is a top‐down process, beginning with the allocation of cognitive resources (numerical Stroop task) and leading to a reduced efficiency of the descending pain control mechanisms.…”

“…This is nothing else than what sportsmen define as ‘mental energy recovery’ between two consecutive competitions. Second, in the study by Silvestrini and Raiville's (), the subjects were asked to rate pain due to a train of electrical stimuli. Each train was very short, lasting 30 ms.…”

“…Some points remain to be elucidated and will have to be investigated in future studies. First, as was also underlined by Silvestrini and Rainville (2013), it is not clear whether the effective depletion of cognitive resources per se or merely the subjective perception of such depletion is responsible for the increased subsequent pain perception. Indeed, if submitted to a highly demanding cognitive task, one could feel less able to cope with a subsequent painful stimulus, independent of the effective consumption of cognitive resources.…”