Executive Functioning in Adolescents with Chronic Musculoskeletal Pain.

Kristen E Jastrowski Mano,Susmita Kashikar-Zuck,Emily A Beckmann,Lauren M Fussner

doi:10.3390/children7120273

Abstract

Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the ages of 12 and 17 years (M = 14.57). Thirty participants with chronic musculoskeletal pain and 30 age- and gender-matched healthy controls were recruited from a large Midwestern children’s hospital in the United States. Participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF-2) as well as multiple measures of functional impairment across key domains: school, social, emotional (anxiety, depression), and physical. Adolescents with chronic musculoskeletal pain reported significantly greater EF impairment compared to healthy age- and gender-matched peers. Clinically elevated risk levels of impairment were reported across all aspects of EF, with many adolescents in the chronic pain group scoring above the clinical risk cut off for working memory (52%), inhibition (45%), and cognitive flexibility (38%). EF was also significantly related to functional impairment across all domains. Findings suggest that EF may have an impact across several critical domains of functioning for youth with chronic pain.

Highlights

Pediatric chronic pain is a critically important health problem [1] associated with profound impairments in several areas of daily living, including school [2,3,4,5], peer relationships [6], and emotional functioning [7,8,9]
One critical mechanism in relation to functional impairment that has yet to be thoroughly investigated in pediatric chronic pain is executive functioning (EF), which refers broadly to a set of cognitive processes that are central to self-regulatory functions [10,11]
Among youth with type I diabetes, EF is viewed as a vulnerability factor linked to self-management, such that EF deficits are related to poorer adherence, which, in turn, predicts poorer glycemic control [21,22]

Summary

Introduction

Pediatric chronic pain is a critically important health problem [1] associated with profound impairments in several areas of daily living, including school [2,3,4,5], peer relationships [6], and emotional functioning [7,8,9]. One critical mechanism in relation to functional impairment that has yet to be thoroughly investigated in pediatric chronic pain is executive functioning (EF), which refers broadly to a set of cognitive processes that are central to self-regulatory functions (i.e., processes involved in controlling one’s behavior, emotions, and thoughts in the pursuit of a goal) [10,11]. This gap in knowledge exists despite the documented deleterious influence of pain on attention [12,13,14] and accumulating evidence suggesting that EF negatively impacts functioning and exacerbates pain-related disability [15,16].

Results

Discussion

Conclusion