Fatigue and cognitive fatigability in patients with chronic pain

Holmqvist, Anna; Berginström, Nils; Löfgren, Monika; Stålnacke, Britt-Marie; Möller, Marika C. · 2024 · Crossref

DOI: 10.1515/sjpain-2023-0085

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Summary

This study investigates the presence of cognitive fatigability (CF)—defined as objective performance decline during sustained mental effort—in patients with chronic pain, addressing a gap in research regarding objectively measurable cognitive aspects of fatigue. While fatigue is a common and disabling symptom in chronic pain, previous studies have primarily relied on subjective self-assessments. The authors aimed to determine if patients with chronic pain exhibit higher CF than healthy controls and to examine the relationships between CF, attention functions, self-rated fatigue, pain characteristics, sleep disturbance, depression, and anxiety. The study included 200 patients with chronic pain (aged 18–50) and a reference group of 36 healthy subjects. Participants underwent a comprehensive neuropsychological test battery. CF was measured using the Wechsler Adult Intelligence Scale-III Coding subtest, assessing performance changes over time. Attention and processing speed were evaluated using the Ruff 2 & 7 selective attention test and Digit Span. Subjective fatigue was measured via the Multidimensional Fatigue Inventory-20 (trait fatigue) and a Visual Analog Scale (state fatigue). Additional measures included the Hospital Anxiety and Depression Scale, Insomnia Severity Index, and pain intensity and spreading assessments. The results indicated no significant difference in CF between the chronic pain group and the reference group, contradicting the initial hypothesis. However, within the chronic pain group, CF was significantly associated with processing speed on tests of sustained and selective attention, particularly under conditions requiring higher-order cognitive control. In contrast, CF showed no significant correlation with self-rated fatigue, pain intensity, pain spreading, sleep disturbance, anxiety, or depression. Conversely, self-rated fatigue measures were highly correlated with each other and with pain intensity, pain spreading, depression, anxiety, and sleep disturbance. Patients reported significantly higher levels of subjective fatigue, anxiety, and depression than the reference group, but objective cognitive performance, aside from slower processing speed, did not differ significantly between groups. The findings highlight a clear distinction between objective cognitive fatigability and subjective fatigue in chronic pain patients. The lack of association between CF and emotional or pain-related factors suggests that these aspects of fatigue may have different underlying mechanisms. The study implies that while a subgroup of patients may suffer from attention deficits and CF, standard subjective measures do not capture this objective decline. The authors suggest that implementing cognitive screening as a standard diagnostic tool could help identify patients who might benefit from targeted interventions, such as attention training, early in their rehabilitation process.

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