(179) Depression mediates the relationship between pain intensity and effort in minor, but not major, decision making

Abstract

Studies have reported a link between chronic pain and impairment in some aspects of cognitive function.1 One such difficulty is decision-making, which has been found to be impaired in some individuals with chronic pain. Although the mechanisms behind this impairment are not well understood, one potential explanation for this difficulty is mood disturbance. Consequently, the current study sought to examine the link between pain and decision-making, and whether this relationship might be explained by the degree of depressive symptomatology reported by participants. Individuals with self-reported chronic low back pain were invited to participate in an internet survey-based study, administered using the REDCap system, including questionnaires concerning pain, depressive symptoms, and effort spent on minor and major decision making. Data were collected on 219 participants. Structural path modeling analyses revealed both average pain intensity over the prior 6 months (β=0.242, p<0.01) and depressive symptoms (β = .343, p < .01) predicted a greater degree of effort spent on making daily, minor decisions. Depressive symptoms (β = .178, p < .05), but not pain intensity (β = .021, p > .10) predicted effort in making major, life-changing decisions. Further, depressive symptoms fully mediated the relationship between pain intensity and effort in minor decision making but did not mediate the relationship between pain and effort in major decision-making. Self-reported pain intensity predicts increased effort in minor, but not major, decision-making, which was mediated by the presence of depressive symptoms. The current findings highlight the importance of pain-related emotional distress in disrupting decision-making in daily life, though major life decisions may occur independently of pain. Further clarification of these relationships may aid in understanding the decision-making difficulties reported by people with chronic pain. (1. Apkarian, Pain, 2004.) Funding provided by National Institute for Drug Abuse K23DA031808, 3T32DA035165-02S1, K24 DA029262, and the Redlich Pain Endowment.