Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Chronic Pain and Neuropsychological Functioning

  • 1449 Accesses

  • 165 Citations

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.

This is a preview of subscription content, log in to check access.

REFERENCES

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

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

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

  14. 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.

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

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

  17. 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.

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

  19. 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.

  20. 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.

  21. 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.

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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.

  32. 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.

  33. 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.

  34. 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.

  35. 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.

  36. 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.

  37. 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.

  38. 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.

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

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

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

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

  43. 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.

  44. 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.

  45. 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.

  46. 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.

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

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

  49. 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.

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

  51. 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.

  52. 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.

  53. 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.

  54. 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.

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

  56. 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.

  57. 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.

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

  59. 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.

  60. 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.

  61. 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.

  62. 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.

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

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

  65. 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.

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

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

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

  69. 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.

  70. 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.

  71. 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.

  72. 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.

  73. 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.

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Chronic pain
  • neuropsychological functioning