The Relation of Pain Chronification Factors and Neurocognition in Chronical Pain Syndrome A Secondary Analysis of a Prospective Clinical Study

Abstract

Objective: In the ICD-11, pain duration of at least three-months was maintained as main criterion for defining chronic pain. Psychosocial risk factors, commonly referred to as "yellow flags", offer insights into psychological risk factors that contribute to the process of chronification. Psychological factors that contribute to chronification are associated with neurocognitive performance. Thus, our research investigates the impact of pain duration, a key indicator of pain chronification, along with other pertinent psychological factors influencing chronicity, on neurocognitive functioning. Methods: A cohort of 40 patients with chronic pain syndrome (CP) and 41 healthy controls (HC) with no significant between group differences in age, gender, education, or intelligence underwent thorough assessments. Assessments included comprehensive neurocognitive evaluations conducted at three time points and a standardized driving simulator task. Results: The results of this study demonstrate that relations of pain duration on neurocognition exist, but nearly disappear when considering relevant factors contributing to chronicity. The results revealed key factors associated with chronification, referred to as "yellow flags”, with predictive impacts on neurocognition. These factors encompassed affective pain perception and pain-induced psychological helplessness, serving as indicators of pain processing. Conclusion: The study underscores the significance of understanding factors contributing to pain chronification and their impact on cognition. Yellow flags and their impact on cognition should be given more consideration in basic science as well as in clinical and therapeutic settings.