Clinical pain, abstraction, and self-control: being in pain makes it harder to see the forest for the trees and is associated with lower self-control

Abstract

ObjectivesAlthough abstract thinking is a fundamental dimension of human cognition, it has received scant attention in research on pain and cognition. We hypothesized that physical pain impairs abstraction, because when people experience pain at high intensity levels, attention becomes concretely focused on the self in the here and now, where little else matters than finding relief for the pain they are currently experiencing. We also examined the relationship between pain and self-control, predicting that pain would debilitate self-control.Patients and methodsAbstraction and self-reported self-control were assessed in 109 patients with musculoskeletal pain. The influence of specific pain qualities, such as pain intensity, pain interference with daily activities, pain duration, and pain persistence, was examined. Furthermore, we assessed other factors (e.g., anxiety, depression, and fatigue) that could be assumed to play a role in the pain experience and in cognitive performance.ResultsHigher pain intensity and persistence were associated with less abstract thinking. Furthermore, self-control decreased with greater pain intensity, persistence, and self-reported pain interference with daily activities. Self-reported depressive symptoms mediated the overall relationship between pain and self-control.ConclusionAbstraction is compromised in patients reporting higher pain intensity and persistence. Different dimensions of pain also predict lower self-control although depression seems to account for the relationship between overall pain and self-control. The current study is the first to report an association between clinical musculoskeletal pain and abstraction. The results suggest that pain patients may suffer from a broader range of cognitive disadvantages than previously believed.

An investigation of the effect of experimental pain on logical reasoning

“…It is possible that naturally-occurring pain would influence reasoning Reasoning in pain 31 behaviour in a way that experimental pain did not in these experiments. Recent studies have found that while experimental pain did not change abstract thinking behaviour [1], the intensity of clinical pain did [23]. The benefit of using experimental pain is that we can isolate the effects of pain from the effects of confounds such as other health problems, depression, and pain-related anxiety.…”

“…There is evidence that pain disrupts attention [4; 6-8; 27; 32; 33; 44; 46], but the impact of pain on higher-level cognitive processes is less-investigated (although see [1,23,28]). It is unclear whether we should expect higher-level tasks to also be affected by pain.…”

People in pain make poorer decisions

“…Few studies have examined the effects of pain on higher-level cognition. One which did, found that clinical pain was associated with less-abstract thinking [20], while another found no evidence that experimentally-induced pain affected abstract thinking [2]. Here, we focus on the potential impact of pain on higher-level real-world cognitive tasks requiring attention, namely numerical reasoning and decision making, which have serious consequences if one gets them wrong.…”

Is clinical, musculoskeletal pain associated with poorer logical reasoning?

“…The reason for this is that differences in the duration and persistence of pain could affect the brain differently, even in patients within the chronic pain group. 4,22,24 Impaired logical reasoning could be detrimental to both the society and the individual with pain. If it is found that clinical, musculoskeletal pain impairs logical reasoning, the effects could have nontrivial consequences for life domains, such as education, problem solving, and risk assessment.…”