Pain catastrophizing, perceived pain disability, and pain descriptors in veterans: The association with neuropsychological performance.

Abstract

This study examined neuropsychological performance in relation to specific aspects of pain. Pain catastrophizing, pain disability, and sensory, affective, and evaluative descriptors of pain were examined in relation to neuropsychological test performance to understand the relationship between chronic pain and altered cognitive function. Diagnostic interviews, symptoms measures, and neuropsychological testing were completed with veteran participants to examine pain conditions and objective neuropsychological performance. Participants completed the Structured Clinical Interview for DSM-IV-TR, clinician-rated symptom measures (Hamilton Depression and Hamilton Anxiety rating scales), and a neuropsychological battery (Controlled Oral Word Association test, Stroop, Trail Making Test, Ruff 2 & 7, and California Verbal Learning Test, 2nd edition). Pain was measured with the McGill Pain Questionnaire, the Pain Disability Index, and the Pain Catastrophizing Scale. Findings revealed that learning and memory were associated with both pain catastrophizing and perceived pain disability, but not affective or evaluative descriptions of pain. Executive function and attention were not related to any of the pain characteristics examined in this study. Of important note, neuropsychological performance was not related to mental health functioning in this veteran sample. These findings suggest that separate from anxiety and depression, learning and memory specifically are influenced by pain-specific catastrophizing as well as pain-specific perceived disability. Understanding the cognitive mechanism associated with chronic pain and neuropsychological performance may result in new treatment targets.

Executive Functions and Pain

“…Upon testing whether depressive symptoms might explain the relation between chronic pain and executive functioning, three studies found confi rming evidence (Gijsen et al, 2011;Jongsma et al, 2011;van der Leeuw et al, 2016). However, even more studies failed to show that depressive symptoms can explain the executive functioning defi cits in chronic-pain patients (Abeare et al, 2010;Akdoğan et al, 2013;Armstrong et al, 1997;Dick et al, 2002;Glass et al, 2011;Grace et al, 1999;Grisart & Plaghki, 1999;Hall et al, 2011;Ickmans et al, 2015;Karp et al, 2006;Legaretta et al, 2016;Luerding et al, 2008;Miró et al, 2011;Murata et al, 2017;Park et al, 2001;Weiner et al, 2006). Therefore, depressive symptoms seem to play only a minor role in the association between chronic pain and executive functioning.…”

The Relationship between Pain Catastrophizing and Cognitive Function in Chronic Musculoskeletal Pain: A Scoping Review

“…This group of studies ( n = 11) was comprised of a population of syndromes or diagnoses that lack specific explanation as they relate to a definitive structure or tissue. Four studies found significant relationships between a high level of pain catastrophizing and poor cognitive function on a variety of tests [ 25 , 63 – 65 ]. Three studies [ 66 – 68 ] found no association between pain catastrophizing and cognition, whereas four others identified the frequent presence of these variables together in CMP populations without testing specific relationships [ 69 – 72 ].…”

“…The accepted cutoffs for “clinically meaningful” pain catastrophizing are ≥30 points on the PCS [ 42 , 77 ], ≥20 points on the CSQ [ 78 ], and >3.81 on the PRSS [ 44 , 79 ]. Only four studies [ 46 , 52 , 57 , 65 ] met the threshold for their respective pain catastrophizing measures, whereas 22 studies [ 47 – 51 , 54 , 56 , 58 – 64 , 66 – 72 , 80 ] reported the mean scores less than the cutoffs in their participants, and four studies did not report the mean scores of their pain catastrophizing measures [ 25 , 53 , 81 ]. Without sample means for pain catastrophizing, results from these studies cannot be generalized to determine the relationship between clinically relevant pain catastrophizing and cognitive function.…”

“…Any score equal to or higher than the cutoff scores indicates a significant clinical manifestation of pain catastrophizing overall or in the specific domain. Only three of the studies reviewed included subdomain scores in their analyses [ 25 , 54 , 65 ], and two studies found significant correlations between cognitive performance and PCS total scores, as well as the rumination subdomain [ 25 , 65 ]. As the three domains of the PCS represent different constructs in the pain experience, the individual domain scores could further specify the areas of cognitive deficits [ 82 ].…”

Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions

“…Similar deficits in attentional control are found in those with high pain catastrophizing ( 39 ). Impaired cognitive flexibility, attentional inhibition, attentional interference, learning, and memory are also associated with high levels of pain catastrophizing ( 40 , 41 ). Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear.…”