Pain, Executive Functioning, and Affect in Patients With Rheumatoid Arthritis

Abstract

Objectives Rheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. Methods A sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the WAIS-III and the Stroop Color Word Test tests, respectively. Results: Consistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. Discussion These findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning as well as functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.

Sociodemographic factors associated with functional disability in outpatients with rheumatoid arthritis in Southwest China

“…It may be explained by the fact that pain increased the difficulty of valued activities and decreased the executive function [31,32]. Meanwhile, pain could restrict the activity of arthritis and consequently lead to disused disability [11,33,34].…”

Cognitive Impairment in Rheumatoid Arthritis: A Systematic Review

“…The inclusion, measurement, and severity of clinical variables varied considerably across studies. The following variables were found to be associated with cognitive function: pain (23,29,31,36,38), disease activity (32,33), fatigue (37), medication (prednisone/steroids [31,40] and MTX [30]), biomarkers (interleukin-6, B cells, and T cells) (34,35,40), and cardiovascular disease risk factors (30). A range of assessment tools was used across studies, prohibiting systematic comparison of clinical profile across samples.…”

Beyond pain: modeling decision-making deficits in chronic pain

“…Pain is a dynamical (Foss et al, 2006) and highly attention-demanding sensory phenomenon (Eccleston and Crombez, 1999) which requires cognitive processing such as learning, recall of past experiences and active decision making (Keefe et al, 2001; Apkarian et al, 2004; Bechara and Damasio, 2005; Montoya et al, 2005; Solberg Nes et al, 2009; Abeare et al, 2010). Moreover, it is known that cognitive interventions including distraction, hypnosis, or mindfulness may have analgesic effects and that cognitive functioning seems to be markedly disrupted in patients with chronic pain (Must et al, 2006; Moriarty et al, 2011).…”