Delay discounting in adults with and without chronic pain: Differentiation across commodity and sign.

Abstract

Delay discounting is a component of reward processing that affects decision-making in various health behavior domains. This study examined the discounting of gains and losses for monetary and pain outcomes among adults with and without chronic pain. Pain severity and pain catastrophizing (PC) were examined as additional moderators. This study assessed the discounting rates of 138 adults with chronic pain and 147 adults without chronic pain using online convenience sampling. Delay discounting was measured using an adjusting amount procedure, which titrates discounting rates based on participants' responses to identify points of indifference. Adults with and without chronic pain discounted losses more than gains and discounted pain outcomes more than monetary outcomes. There were no differences between groups based on chronic pain status or average self-reported pain severity. Post hoc analyses show that, on average, adults with chronic pain and high pain catastrophizing discounted monetary losses less than adults without chronic pain and low pain catastrophizing. This finding suggests that a tendency to defer immediate losses in favor of even larger delayed losses is dependent on high pain catastrophizing in the context of chronic pain. If pain catastrophizing is a more robust predictor of discounting rates than other pain metrics, then catastrophizing may be the construct that predicts risky decision-making. Public Health SignificanceDiscounting rates of monetary and pain rewards were similar in adults with and without chronic pain. Adults with pain and high pain catastrophizing discounted monetary losses less than adults without chronic pain and low pain catastrophizing. This study suggests that catastrophizing may predict risky decision-making in adults with chronic pain, which may have implications for psychological and pharmacological interventions.

The role of chronic pain and pain anxiety in delay discounting of pain and monetary losses

“…Similarly to previous research 15 , 16 , we did not observe a direct relationship between CP and the discounting of monetary losses. However, in light of results that show that the discounting of losses and gains are, to a considerable extent, independent processes 27 , 28 between which there no significant correlation 29 , this result does not necessarily contradict the results of Wakaizumi et al 14 , and Herman and Stanton 16 , especially in the context of the observed mediation effects.…”

“…Moreover, the findings are mixed. In contrast to the mentioned studies 14 , 15 , which in terms of discounting rates of monetary and pain outcomes show no direct differences between those who do or do not experience CP, a study by Herman and Stanton 16 revealed that chronic pain leads to short-sighted, more-impulsive decisions in the domain of monetary gains but not monetary losses.…”

“…Yet, our analysis suggests that the relationship cannot be explained by pain-related anxiety levels alone and indicates either a direct or a more complex relationship. For example, Mistretta et al 15 found a significant moderating role of pain catastrophizing on the relation between delay discounting of monetary losses and chronic pain. Participants who were pain-free and were low on pain catastrophizing discounted monetary losses more in comparison to the CP group and those who were high on pain catastrophizing.…”

“…The third limitation of our study is that some comparisons, in the tested path model (see Data analysis section) are underpowered. The sample in this study was a convenience sample, however, unlike in other studies 13 , 15 , 16 , where participants were recruited online, we directly recruited subjects.…”

“…Wakaizumi et al 14 have shown a direct link between CP and changes in discounting rate on both the behavioral and neural levels. Although no direct differences in DD between pain-free people and those experiencing chronic pain were found (see also Mistretta 15 ), it was indicated that the intensity of the experienced pain is associated with steeper discounting of monetary rewards and a change in brain activity in areas associated with DD, compared to the brain activity of healthy controls. These findings indicate that the severity of CP can cause behavioral changes that are crucial for therapy planning; however, they leave numerous questions about the context of the relationships being studied.…”