Abstract
BackgroundEffects from cognitive performance on pain tolerance have been documented, however, sample sizes are small and confounders often overlooked. We aimed to establish that performance on neuropsychological tests was associated with pain tolerance, controlling for salient confounders.MethodsThis was a cross‐sectional study nested within the Tromsø‐6 survey. Neuropsychological test performance and the cold pressor test were investigated in 4,623 participants. Due to significant interaction with age, participants were divided into three age groups (<60, ≥60 to <70 and ≥70 years). Cox proportional hazard models assessed the relationship between neuropsychological tests and cold pressure pain tolerance, using hand‐withdrawal as event. The fully adjusted models controlled for sex, education, BMI, smoking status, exercise, systolic blood pressure, sleep problems and mental distress.ResultsIn the adjusted models, participants aged ≥70 years showed a decreased hazard of hand withdrawal of 18% (HR 0.82, 95% CI (0.73, 0.92) per standard deviation on immediate verbal recall, and a decreased hazard of 23% (HR 0.77, 95% CI (0.65, 0.08) per standard deviation on psychomotor speed. Participants aged ≥60 to <70 years had a significant decreased hazard of 11% (HR 0.89, 95% CI (0.80, 0.98) per standard deviation on immediate word recall. In participants aged <60 years, there was a decreased hazard of 14% (HR 0.86 95% CI: 0.76, 0.98), per standard deviation on psychomotor speed.ConclusionBetter performance on neuropsychological tests increased pain tolerance on the cold pressor test. These exposure effects were present in all age groups.SignificanceThis paper describes substantial associations between cognitive functioning and cold pressor tolerance in 4,623 participants. Reduced psychomotor speed and poor verbal recall gave greater odds for hand‐withdrawal on the cold pressor task. The associations were stronger in older participants, indicating an interaction with age.
Highlights
Pain is a complex phenomenon, which includes sensory‐discriminative, motivational‐affective and cognitive‐behavioral factors (Melzack & Casey, 1968; Turk & Melzack, 2011)
In the age stratified analysis of the first age group (
There was a 14% decreased hazard of hand withdrawal from the water per standard deviation on the coding test (hazard ratio (HR) 0.86, 95% confidence interval (CI) (0.76, 0.98), p = 0.02), controlling for all covariates
Summary
Pain is a complex phenomenon, which includes sensory‐discriminative, motivational‐affective and cognitive‐behavioral factors (Melzack & Casey, 1968; Turk & Melzack, 2011). Neuropsychological tests (or tasks) infer adequacy of cognitive processes through theories about the functioning of underlying neuronal correlates. Within pain research, both neuropsychological tests and underlying theory has been criticized for lack of reliability and delineation (Moriarty, McGuire, & Finn, 2011). Subsequent data have led to a theory, stating that pain demands cognitive resources and limits cognitive functioning due to interference with neural networks (Legrain et al, 2009; Moriarty et al, 2011). Such interference could explain cognitive dysfunction in individuals with persistent pain.
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