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Chronic Pain and Neuropsychological Functioning

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Abstract

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.

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REFERENCES

  • Andary, M. T., Crewe, N., Ganzel, S. K., Haines, P. C., Kulkarni, M. R., Stanton, D. F., Thompson, A., and Yosef, M. (1997). Traumatic brain injury/chronic pain syndrome: A case comparison study. The Clinical Journal of Pain 13: 244–250.

    Google Scholar 

  • Armstrong, C., Lewis, T., D'Esposito, M., and Freundlich, B. (1997). Eosinophilia-myalgia syndrome: Selective cognitive impairment, longitudinal effects, and neuroimaging findings. Journal of Neurology, Neurosurgery and Psychiatry 63: 633–641.

    Google Scholar 

  • Astrand, N. E. (1987). Medical, psychological, and social factors associated with back abnormalities and self reported back pain: A cross-sectional study of male employees in a Swedish pulp and paper industry. British Journal of Industrial Medicine 44: 327–336.

    Google Scholar 

  • Atkinson, J. H., Ancoli-Israel, S., Slater, M. A., Garfin, S. R., and Gillin, J. C. (1988). Subjective sleep disturbance in chronic pain. The Clinical Journal of Pain 4: 225–232.

    Google Scholar 

  • Bell, B. D., Primeau, M., Sweet, J. J., and Lofland, K. R. (1999). Neuropsychological functioning in migraine headache, non-headache chronic pain, and mild traumatic brain injury patients. Archives of Clinical Neuropsychology 14: 1–11.

    Google Scholar 

  • Coderre, T. J., Katz, J., Vaccarino, A. L., and Melzack, R. (1993). Contribution of central neuroplasticity to pathological pain: Review of clinical and experimental studies. Pain 44: 259–285.

    Google Scholar 

  • Cote, K. A., and Moldofsky, H. (1997). Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia. The Journal of Rheumatology 24: 14–23.

    Google Scholar 

  • Denys, P., Azouvi, P., Denormandi, P., and Samuel, C. (1996). Late cognitive and behavioral improvement following treatment of disabling orthopaedic complications of a severe closed head injury. Brain Injury 10: 149–153.

    Google Scholar 

  • Dikmen, S., McLean, A., and Temkin, N. (1986). Neuropsychological and psychosocial consequences of minor head injury. Journal of Neurology, Neurosurgery, and Psychiatry 49: 1227–1232.

    Google Scholar 

  • DiPiero, V., Jones, A. K., Iannotti, F., Powell, M., Perani, D., Lenzi, G. L., and Frackowiak, R. S. (1991). Chronic pain: A PET study of the central effects of percutaneous high cervical cordotomy. Pain 46: 9–12.

    Google Scholar 

  • DiStefano, G., and Radanov, B. P. (1995). Course of attention and memory after common whiplash: A two-years prospective study with age, education and gender pair-matched patients. Acta Neurologica Scandinavia 91: 346–352.

    Google Scholar 

  • Dufton, B. D. (1989). Cognitive failure and chronic pain. International Journal of Psychiatry in Medicine 19: 291–297.

    Google Scholar 

  • Eccleston, C. (1994). Chronic pain and attention: A cognitive approach. British Journal of Clinical Psychology 33: 535–547.

    Google Scholar 

  • Eccleston, C. (1995). Chronic pain and distraction: An experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behavioral Research and Therapy 33: 391–405.

    Google Scholar 

  • Eccleston, C., and Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin 125: 356–366.

    Google Scholar 

  • Eccleston, C., Crombez, G., Aldrich, S., and Stannard, C. (1997). Attention and somatic awareness in chronic pain. Pain 72: 209–215.

    Google Scholar 

  • Eimer, B. N., and Allen, L. M. (1995). Psychological Assessment and Treatment of Chronic Pain and Related Disability. User's Guide to the Pain Assessment Battery-Research Edition, Durham, NC, CogniSyst, Inc.

    Google Scholar 

  • Getto, C. J., and Heaton, R. K. (1985). Psychosocial Pain Inventory. Odessa, FL, Psychological Assessment Resources.

    Google Scholar 

  • Gimse, R., Bjorgen, I. A., Tjell, C., Tyssedal, J. S., and Bo, K. (1997). Reduced cognitive functions in a group of whiplash patients with demonstrated disturbance in the posture control system. Journal of Clinical Experimental Neuropsychology 19: 838–849.

    Google Scholar 

  • Goldberg, M. B., Mock, D., Ichise, M., Proulx, G., Gordon, A., Shandling, M., Tsai, S., and Tenenbaum, H. C. (1996). Neuropsychologic deficits and clinical features of post-traumatic temporo-mandibular disorders. Journal of Orofacial Pain 10: 126–140.

    Google Scholar 

  • Grace, G. M., Berg, M. A., and Nielson, W. (1995). Assessment of attention, concentration, and memory in patients with fibromyalgia. Journal of the International Neuropsychological Society 1: 137.

    Google Scholar 

  • Grace, G. M., Nielson, W. R., Hopkins, M., and Berg, M. A. (1999). Concentration and memory deficits in patients with fibromyalgia syndrome. Journal of Clinical and Experimental Neuropsychology 21: 477–487.

    Google Scholar 

  • Grigsby, J., Rosenberg, N. L., and Busenbark, D. (1995). Chronic pain is associated with deficits in information processing. Perceptual and Motor Skills 81: 403–410.

    Google Scholar 

  • Harkins, S. W., Price, D. D., and Braith, J. (1989). Effects of extraversion and neuroticism on experimental pain, clinical pain, and illness behavior. Pain 36: 209–318.

    Google Scholar 

  • Hinnant, D. W. (1994). Psychological evaluation and testing. In Tollison, D. C., Satterwhite, J. R., and Tollison J. W., (eds.), Handbook of Chronic Pain Management, Williams & Wilkins, Baltimore, MD, pp. 18–35.

    Google Scholar 

  • Jamison, R. N., Sbrocco, T., and Parris, W. C. V. (1988). The influence of problems with concentration and memory on emotional distress and daily activities in chronic pain patients. International Journal of Psychiatry in Medicine 18: 183–191.

    Google Scholar 

  • Jarvis, P., and Kooken, R. (1998). Fibromyalgia: A case study illustrating the relationship between pain and neuropsychological test performance. The Bulletin of the National Academy of Neuropsychology 14: 7–9.

    Google Scholar 

  • Kaplan, R., Meadows, M., Vincent, L., Logigian, E., and Steere, A. (1992). Memory impairment and depression in patients with lyme encephalopathy: Comparison with fibromyalgia and nonpsychotically depressed patients. Neurology 42: 1263–1267.

    Google Scholar 

  • Kewman, D. G., Vaishampayan, N., Zald, D., and Han, B. (1991). Cognitive impairment in musculoskeletal pain patients. International Journal of Psychiatry in Medicine 21: 253–262.

    Google Scholar 

  • King, D. A., Cox, C., Lyness, J. M., and Caine, E. D. (1995). Neuropsychological effects of depression and age in an elderly sample: A confirmatory study. Neuropsychology 9: 339–408.

    Google Scholar 

  • Kulich, R. J., and Baker, W. B. (1999). A guide for psychological testing and evaluation for chronic pain. In Aranoff, G. M. (ed.), Evaluation and Treatment of Chronic Pain, Williams and Wilkins, Baltimore, MD, pp. 301–312.

    Google Scholar 

  • Landro, N. I., Stiles, T. C., and Sletvold, H. (1997). Memory functioning in patients with primary fibromyalgia and major depression and healthy controls. Journal of Psychosomatic Research 42: 297–306.

    Google Scholar 

  • Lake, A. E., Branca, B., Lutz, T. E., and Saper, J. R. (1999). Headache level during neuropsychological testing and test performance in patients with chronic post-traumatic headache. Journal of Head Trauma Rehabilitation 14: 70–80.

    Google Scholar 

  • Levin, H. S., Mattis, S., Ruff, R., Eisenberg, H. M., Marshall, L. F., Tabaddor, K., High, W. M., and Frankowski, R. F. (1987). Neurobehavioral outcome following minor head injury: A three-center study. Journal of Neurosurgery 66: 234–243.

    Google Scholar 

  • Loeser, J. D. (1982). Concepts of pain. In Stanton-Hicks, M., and Boas, R. (eds.), Chronic Low Back Pain, Raven, New York, pp. 145–148.

    Google Scholar 

  • Lorenz, J., Beck, H., and Bromm, B. (1997). Cognitive performance, mood and experimental pain before and during morphine-induced analgesia in patients with chronic non-malignant pain. Pain 73: 369–375.

    Google Scholar 

  • Martelli, M. F., Grayson, R., and Zasler, N. D. (1999). Post traumatic headache: Psychological and neuropsychological issues in assessment and treatment. Journal of Head Trauma Rehabilitation 1: 49–69.

    Google Scholar 

  • Martelli, M. F., Zasler, N. D., Mancini, A. M., and MacMillan, P. (1999). Psychological assessment and applications in impairment and disability evaluations. In May, R. V., and Martelli, M. F. (eds.), Guide to Functional Capacity Evaluation with Impairment Rating Applications, NADEP Publications, Richmond, VA, pp. 3–1–3–84.

    Google Scholar 

  • Melzack, R. (1996). Gate control theory. Pain Forum 5: 128–138.

    Google Scholar 

  • Melzack, R. (1999). From the gate to the neuromatrix. Pain Supplement 6: 121–126.

    Google Scholar 

  • Melzack, R., and Wall, P. D. (1965). Pain mechanisms: A new theory. Science 150: 971–979.

    Google Scholar 

  • Miller, L. (1990). Chronic pain complicating head injury recovery: Recommendations for clinicians. Cognitive Rehabilitation 8: 12–19.

    Google Scholar 

  • Morin, C. M., Gibson, D., and Wade, J. (1998). Self-reported sleep and mood disturbance in chronic pain patients. The Clinical Journal of Pain 14: 311–314.

    Google Scholar 

  • Mountz, J. M., Bradley, L. A., and Alarcón, G. S. (1998). Abnormal functional activity of the central nervous system in fibromyalgia syndrome. American Journal of Medical Science 315: 385–396.

    Google Scholar 

  • Mountz, J. M., Bradley, L. A., Modell, J. G., Alexander, R. W., Triana, A., Aaron, L. A., Stewart, K. E., Alarcón, G. S., and Mountz, J. D. (1995). Fibromyalgia in women: Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis and Rheumatology 38: 926–938.

    Google Scholar 

  • Nicholson, K. (1998, November). The neuropsychology of pain (Towards a neuropsychology of pain?). Paper presented at the meeting of the National Academy of Neuropsychology, Washington, DC.

  • Pilcher, J. J., and Huffcutt, A. L. (1996). Effects of sleep deprivation on performance: A meta analysis. Sleep 19: 318–326.

    Google Scholar 

  • Pincus, T., Fraser, L., and Pearce, S. (1998). Do chronic pain patients 'Stroop' on pain stimuli? British Journal of Clinical Psychology 37: 49–58.

    Google Scholar 

  • Pollina, D. A., Kaufman, L. D., Masur, D. M., and Krupp, L. B. (1998). Pain, fatigue, and sleep in eosinophilia-myalgia syndrome: Relationship to neuropsychological performance. Journal of Neuropsychiatry and Clinical Neuroscience 10: 338–342.

    Google Scholar 

  • Price, D. D. (1988). Psychological and neural mechanisms of pain, Raven, New York.

    Google Scholar 

  • Puca, F. M., Prudenzano, A. M. P., Savarese, M., Genco, S., and Specchio, L. M. (1997). Stress, mood disorders and memory in headache. International Journal of Clinical Pharmacology Residency 17: 111–114.

    Google Scholar 

  • de Quervin, D. J., Roozendaal, B., and McGraugh, J. L. (1998). Stress and glucocorticoids impair retrieval of long-term spatial memory. Nature 394: 787–790.

    Google Scholar 

  • Radanov, B. P., DiStefano, G., Schnidrig, A., Sturzenegger, M., Genco, S., and Augustiny, K. F. (1993). Cognitive functioning after common whiplash. A controlled follow-up study. Archives of Neurology 50: 87–91.

    Google Scholar 

  • Radanov, B. P., Dvorak, J., and Valach, L. (1992). Cognitive deficits in patients after soft tissue injury of the cervical spine. Spine 17: 127–131.

    Google Scholar 

  • Radanov, B. P., Hirlinger, I., DiStefano, G., and Valach, L. (1992). Attentional processing in cervical spine syndromes. Acta Neurologica Scandinavia 85: 358–362.

    Google Scholar 

  • Rudy, T. E., and Turk, D. C. (1989). Multiaxial assessment of pain: Multidimensional pain inventory computer program user manual version 2.1, University of Pittsburgh, Pittsburgh, PA.

    Google Scholar 

  • Schmand, B., Lindeboom, J., Schagen, S., Heijt, R., Koene, T., and Hamburger, H. L. (1998). Cognitive complaints in patients after whiplash injury: The impact of malingering. Journal of Neurology, Neurosurgery, and Psychiatry 64: 339–343.

    Google Scholar 

  • Schnurr, R. F., and MacDonald, M. R. (1995). Memory complaints in chronic pain. The Clinical Journal of Pain 11: 103–111.

    Google Scholar 

  • Schwartz, D. P., Barth, J. T., Dane, J. R., Drenan, S. E., DeGood, D. E., and Rowlingson, J. C. (1987). Cognitive deficits in chronic pain patients with and without a history of head/neck injury: Development of a brief screening battery. The Clinical Journal of Pain 3: 94–101.

    Google Scholar 

  • Sendrowski, D. P., Buker, E. A., and Gee, S. S. (1997). An investigation of sympathetic hypersensitivity in chronic fatigue syndrome. Optometry and Visual Science 74: 660–663.

    Google Scholar 

  • Sletvold, H., Stiles, T. C., and Landro, N. I. (1995). Information processing in primary fibromyalgia, major depression and healthy controls. Journal of Rheumatology 22: 137–142.

    Google Scholar 

  • Taylor, A. E., Cox, C. A., and Mailis, A. (1996). Persistent neuropsychological deficits following whiplash: Evidence for chronic mild traumatic brain injury? Archives of Physical Medicine and Rehabilitation 77: 529–535.

    Google Scholar 

  • Treede, R. D., Kenshalo, D. R., Gracely, R. H., and Jones, A. (1999). The cortical representation of pain. Pain 79: 105–111.

    Google Scholar 

  • Tsushima, W. T., and Newbill, B. A. (1996). Effects of headaches during neuropsychological testing of mild head injury patients. Headache 36: 613–615.

    Google Scholar 

  • Turk, D. C., and Holzman, A. D. (1986). Chronic pain: Interfaces among physical, psychological and social parameters. In Holzman, A. D., and Turk, D. C. (eds.), Pain Management: A Handbook of Psychological Treatment Approaches, Pergammon Press, New York, pp. 1–9.

    Google Scholar 

  • Turk, D. C., and Rudy, T. E. (1987). Towards comprehensive assessment of chronic pain patients. Behavioral Research & Therapy 25: 237–249.

    Google Scholar 

  • Veill, H. O. F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Psychology 19: 587–603.

    Google Scholar 

  • Vernon-Wilkinson, R., and Tuokko, H. (1993). The influence of pain symptoms on neuropsychological test scores. Archives of Clinical Neuropsychology 9: 2.

    Google Scholar 

  • Vogt, B. A., Derbyshire, S., and Jones, A. K. (1996). Pain processing in four regions of human cingulate cortex localized with co-registered PET and MR imaging. European Journal of Neuroscience 8: 461–1473.

    Google Scholar 

  • Wade, J. B., Dougherty, L., Hart, R. P., Rafii, A., and Price, D. D. (1992). A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering, and pain behavior. Pain 51: 67–73.

    Google Scholar 

  • Walsh, N. E., Dumitu, D., Ramanurthy, S., and Schoenfeld, L. S. (1988). Treatment of the patient with chronic pain. In DeLisa, J. A., Currie, D. M., Gans, B. M., Gatens, P. F., Leondard, J. A., and McPhee, M. C. (eds.), Rehabilitation Medicine: Principles and Practice, J. B. Lippincott, Philadelphia, PA.

    Google Scholar 

  • Woolf, C. J., and Thompson, S. W. N. (1991). The induction and maintenance of central censitization is dependent of N-methyl D-aspartic acid receptor activation: Implications for treatment of post-injury pain hyperalgesic states. Pain 44: 293–299.

    Google Scholar 

  • Ziegler, D. K., and Paolo, A. M. (1995). Headache symptoms and psychological profile of headache-prone individuals. A comparison of clinic patients and controls. Archives of Neurology 52: 602–606.

    Google Scholar 

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Hart, R.P., Martelli, M.F. & Zasler, N.D. Chronic Pain and Neuropsychological Functioning. Neuropsychol Rev 10, 131–149 (2000). https://doi.org/10.1023/A:1009020914358

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