Executive functioning is associated to everyday interference of pain in patients with chronic pain

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

DOI: 10.1371/journal.pone.0313187

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Summary

This study investigates the relationship between executive functioning and the everyday interference of pain in patients with chronic pain. While cognitive dysfunction is recognized as a component of the chronic pain experience, the specific link between executive functions and pain management has not been extensively explored. The researchers aimed to determine if lower executive functioning is associated with higher pain interference and reduced life control, and whether these cognitive functions correlate with pain characteristics such as intensity, duration, and spreading. The study included 189 outpatients (160 women, 29 men; mean age 33.15) referred for rehabilitation at specialist clinics in Sweden. Participants underwent extensive neuropsychological assessments measuring executive functions, including working memory (Digit Span Backwards), inhibition and switching (Color-Word Interference Test), and verbal fluency (Word Fluency, Semantic Fluency, Semantic Shifting). Self-assessment questionnaires measured pain interference, life control, and kinesiophobia (fear of movement) using the Multidimensional Pain Inventory and Tampa Scale for Kinesiophobia. Pain characteristics and levels of anxiety and depression were also recorded. Statistical analyses included bivariate correlations and multiple linear regressions, adjusting for covariates such as age, gender, education, and depression. The results indicated that several aspects of executive functioning were significantly associated with self-assessed everyday interference of pain after adjusting for covariates. Specifically, better performance on tests of semantic fluency, switching fluency, and inhibition was correlated with lower pain interference and higher life control. Notably, the relationship between word fluency and pain interference reached significance only after adjustment for covariates. Conversely, pain characteristics—including intensity, duration, and spreading—were not significantly associated with executive functioning after controlling for confounding variables. Depression was a significant contributor in all regression models, highlighting its strong association with pain self-management. These findings suggest that preserved executive functions are related to better coping with pain and greater control over daily life, rather than directly influencing the pain experience itself. The study implies that cognitive resources play a crucial role in managing the functional impact of chronic pain. The authors conclude that patients with lower executive functioning, particularly those also experiencing depression, may require special attention during rehabilitation to support their self-management capabilities. This highlights the importance of addressing cognitive and emotional factors in comprehensive pain management strategies.

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• executive function