John Libbey Eurotext




Impact of chronic pain on cognition and concomitant psychological factors
Revue de neuropsychologie. Volume 4, Number 1, 53-69, Mars 2012, Article de synthèse
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Author(s) : Michelle Beaupré, Michelle McKerral
Summary : This review article examines the current state of knowledge of the impact of chronic pain (CP) on cognitive/neuropsychological functioning, with a particular focus of the effect of psychological concomitants. A first section focuses on the neuropsychological functioning of patients with CP without a specific ætiology, while a second section discusses the neuropsychological functioning of fibromyalgia patients. Studies reviewed identified deficits in attention, memory, and executive functioning in these two groups. Results of studies suggest an association between attentional problems, and high intensity pain. In CP, symptoms of anxiety and depression, as well as high somatic awareness and a tendency towards catastrophization often present conjointly with cognitive deficits, but their presence is not necessary for impacts on cognition to be apparent. Self-regulation, a central element of executive functioning, also appears to be affected, and could be intimately related to the ability to manage cognitive and emotional resources, as well as to the maintenance of CP. Literature provides some evidence that this relationship between high intensity pain, psychological/emotional factors, and cognitive deficits may be accounted for by neuropathological changes that occur in CP. These include pathophysiological processes ( e.g., reduction in gray matter, neurochemical changes in N-acetylaspartate/creatine) at the thalamocortical level, in particular in prefrontal cortex, which is simultaneously involved in cognition, pain perception, and emotional control. Implications for neuropsychological evaluation include the need for systematic assessment of attentional and executive functions in CP patients. As well, pain-related (pain intensity, somatic awareness, catastrophization, etc.) and psychological factors (anxiety, depression) should be assessed in order to correctly interpret neuropsychological findings, and provide adequate treatment referral.
Keywords : chronic pain, neuropsychological functioning, psychological factors

Impact of chronic pain on cognition and concomitant psychological factors