Beyond pain: modeling decision-making deficits in chronic pain

Abstract

Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT) is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls (HCs). In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and HCs at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in HCs was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis.

The Relationship Between Chronic Pain and Neurocognitive Function

“…[37,38] A preliminary study (N=30) suggests that patients with fibromyalgia showed high sensitivity to immediate gains at the expense of future losses, as compared with controls, on the Iowa Gambling task, a task of decision making in the context of varying reward and punishment contingencies. [39] Chronic pain patients demonstrated impaired probabilistic learning, perseverating responses that yield high immediate gains but higher future losses, although these patients also exhibited more random, less perseverative behavior than healthy controls. [39] Results of these studies of risk-based decision-making suggest that additional research is necessary to further explore the role of chronic pain in executive functioning in fibromyalgia patients and to determine whether reward-based decision-making is altered in other chronic pain conditions.…”

“…[39] Chronic pain patients demonstrated impaired probabilistic learning, perseverating responses that yield high immediate gains but higher future losses, although these patients also exhibited more random, less perseverative behavior than healthy controls. [39] Results of these studies of risk-based decision-making suggest that additional research is necessary to further explore the role of chronic pain in executive functioning in fibromyalgia patients and to determine whether reward-based decision-making is altered in other chronic pain conditions. In contrast, other studies examining executive functioning in fibromyalgia revealed mixed findings, with some demonstrating deficits compared with those without fibromyalgia [14,38,40] and others not [12,41] , highlighting the possible influence of mediating and moderating factors, discussed in detail below.…”

“…Hess et al 2014 [39] Executive functioning Fibromyalgia (n=15) vs healthy controls (n=15) Fibromyalgia diagnosis made via medical interview…”

No exchange, same pain, no gain: Risk–reward of wearable healthcare disclosure of health personally identifiable information for enhanced pain treatment

“…Individuals with chronic pain may have compromised decision-making capabilities [34][35][36][37][38][39][40] as "chronic pain should be considered a 'cognitive state,' and that it may thus be competing with other cognitive abilities." 34 Furthermore, daily coping of the multiple aspects of pain management can become an overpowering experience for individuals suffering from chronic pain.…”

“…Individuals with chronic pain may have compromised decision-making capabilities 34–40 as “chronic pain should be considered a ‘cognitive state,’ and that it may thus be competing with other cognitive abilities.” 34 Furthermore, daily coping of the multiple aspects of pain management can become an overpowering experience for individuals suffering from chronic pain. 23 Individuals with such compromised decision-making capabilities, according to Waisel’s definition, 41 can be labeled a vulnerable population.…”