Executive Functions and Pain

Abstract

Abstract. A growing body of literature suggests that chronic-pain patients suffer from problems in various neuropsychological domains, including executive functioning. In order to better understand which components of executive functioning (inhibition, shifting and/or updating) might be especially affected by pain and which mechanisms might underlie this association, we conducted a systematic review, including both chronic-pain studies as well as experimental-pain studies. The chronic-pain studies (N = 57) show that pain is associated with poorer executive functioning. The findings of experimental-pain studies (N = 28) suggest that this might be a bidirectional relationship: Pain can disrupt executive functioning, but poorer executive functioning might also be a risk factor for higher vulnerability to pain.

Pain Processing in Older Adults and Its Association with Prefrontal Characteristics

“…Several studies have pointed towards a specific association between cognitive inhibition and endogenous pain inhibition. However, as we could show in our review article, the overall effect size of an association between CPM and cognitive inhibition was only small [48]. The present study could also only demonstrate a small nonsignificant association between cognitive inhibition and CPM (r-values ≤ 0.21).…”

“…A substantial amount of studies have reported a significant association between reduced executive functioning performance and increased pain responses. However, as we could show in a recently published systematic review, the overall strength of this association is only weak [48]. This might be due to the diversity regarding different types of experimental pain responses and executive functioning tests.…”

The Predictive Role of Executive Functions and Psychological Factors on Chronic Pain after Orthopaedic Surgery: A Longitudinal Cohort Study

“…In particular, impairment in executive functions could weaken the ability to flexibly select effective coping strategies to manage pain and associated psychological states. Correlational studies suggest that, in laboratory settings, painful stimulation reduces executive functioning performance [ 9 ]. Regarding post-surgical pain, a longitudinal cohort study by Attal et al assessed the role of cognitive flexibility, visual memory and attention on 89 patients undergoing total knee arthroplasty and 100 patients undergoing breast surgery, finding that cognitive flexibility and visual memory were linked to both pain intensity and the presence of neuropathic pain [ 10 ].…”

Pain Processing in Cognitive Impairment and Its Association with Executive Function and Memory: Which Neurocognitive Factor Takes the Lead?

“…From a neurobiological perspective, alterations in prefrontal functioning are of upmost relevance for changes in central nociception and for deteriorating descending inhibitory control [7][8][9]. From a neurocognitive perspective, there is some tentative evidence that worsening of executive functions is the critical mechanism [10][11][12][13], although the impairment of memory is the leading deficit in most forms of dementia [14,15]. This tentative evidence also appears plausible from a theoretical perspective because coping with pain in time requires a readiness of the individual, (i) who has to stop other ongoing activities, (ii) switch attention towards the noxious event, (iii) recall earlier coping attempts, (iv) plan current coping, and (v) finally monitor as well as (vi) evaluate coping and its results.…”

“…Under this perspective, variations in neurocognitive functioning are always linked to variations in pain processing, even at nonpathological levels. There are several studies, which have tried to investigate this by using cross-sectional designs and correlated executive functioning and pain responses in cognitively healthy individuals [11,12,[16][17][18][19]. Using such designs, most studies (approximately 80%) did not find significant associations between the two functions [12].…”