Patients with chronic pain lack somatic markers during decision-making

Abstract

Abstract:Patients with chronic pain have impaired cognitive functions, including decision making, as shown with the Iowa gambling task (IGT). The main aim of this study was to elucidate whether patients' decision making is associated with a lack of the anticipatory skin conductance response (SCR). An increase in anticipatory SCR before making unfavorable choices is known to guide decisions in healthy controls during the IGT. Since several brain regions involved in decision making are reported to have altered morphology in patients with chronic pain, the second aim was to explore the associations between IGT performance and brain structure volumes. Eighteen patients with chronic pain of mixed etiology and 19 healthy controls matched in terms of age, sex, and education were investigated with a computerized IGT during the recording of SCR, heart rate, and blood pressure. The participants also underwent neuropsychological testing, and three-dimensional T1-weighted cerebral magnetic resonance images were obtained. Contrary to controls, patients did not generate anticipatory SCRs before making unfavorable choices, and they switched between decks of cards during the late phase of the IGT significantly more often, and this was still observed after adjusting for depression scores. None of the other autonomic measures differed during IGT performance in either group or between groups. In patients, IGT scores correlated positively with total cortical grey matter volume. In controls, there was no such association, but their IGT scores correlated with the anticipatory SCR. It may be speculated that the reduction in anticipatory SCRs makes the chronic pain patients rely more on cortical resources during decision making.

The effect of acute pain on risky and intertemporal choice

“…The results indicate that pain increases risk seeking for monetary gains but not for monetary losses. Although in line with previous research on chronic pain patients (Apkarian et al 2004 ; Berger et al 2014 ; Biagianti et al 2012 ; Elvemo et al 2014 ; Tamburin et al 2014 ; Verdejo-García et al 2009 ; Walteros et al 2011 ), these findings partly go against dual-process theories, which predict that inhibition of system 2 leads to greater reliance on automatic biases such as the reflection effect of prospect theory (Evans 2003 ; Evans and Stanovich 2013 ; Kahneman and Frederick 2002 ; Kirchler et al in press; Porcelli and Delgado 2009 ). Thus, our findings suggest that pain does more than inhibit the reflective system 2—it produces risk seeking behavior for potential rewards.…”

“…Patients with chronic pain keep choosing cards from both kinds of decks and therefore end up with less money than controls (Apkarian et al 2004 ; Biagianti et al 2012 ; Tamburin et al 2014 ; Verdejo-García et al 2009 ; Walteros et al 2011 ). This learning impairment seems to be due to a lack of somatic markers, because chronic pain patients’ physiological arousal does not increase when they pick cards from disadvantageous decks, whereas it does in healthy controls (Elvemo et al 2014 ). Patients with chronic pain are also more risk taking on tasks that do not involve a learning component, especially when high potential gains (as opposed to losses) are at stake (Berger et al 2014 ).…”

Hide or Seek? Physiological Responses Reflect Both the Decision and the Attempt to Conceal Information

“…For example, using the famous Iowa gambling task of Bechara and colleagues, participants began to generate anticipatory SCRs whenever they pondered a disadvantageous (risky) choice, before they explicitly knew it was disadvantageous. A few studies that investigated other types of anticipatory responses, such as HR, revealed inconsistent results (e.g., Crone, Somsen, van Beek, & van der Molen, 2004; Crone & van der Molen, 2007; Elvemo, Nilsen, Landrø, Borchgrevink, & Håberg, 2014; Osumi & Ohira, 2009; Studer & Clark, 2011). Moreover, to our knowledge, no previous study has examined whether anticipatory autonomic responses also occur before the decision to conceal information.…”

Pain, Touch, and Decision Making : Behavioral and Brain Responses to Affective Somatosensory Stimulation

“…Patients with chronic pain have been found to have impaired performance in the IGT-that is, they keep choosing cards from both kinds of decks (Apkarian et al, 2004;Biagianti et al, 2012;Tamburin et al, 2014;Verdejo-García et al, 2009;Walteros et al, 2011; but see Mongini et al, 2005). The reduced performance has been suggested to be due to a lack of somatic markers, because patients' physiological arousal does not increase when they choose cards from the bad decks (Elvemo et al, 2014). However, it is unclear from these studies how pain influences risk preferences per se, because the IGT involves choosing between options with initially unknown values and probabilities (and thus involves a learning component rather than simple choices between outcomes with known values and probabilities) and also involves weighting immediate over longer-term outcomes.…”