The effect of acute pain on executive function
Background and Aim: Executive functions are high-level cognitive processes that allow a person to successfully engage in an independent and self-fulfilling life. Previous literature indicates that chronic pain can affect executive function, but there are limited studies that investigate the effect of acute pain on executive function. The purpose of this study was to determine if acute pain affects executive function in recreationally active individuals who sustained a musculoskeletal injury.
Methods: Twenty-four recreationally active participants who presented with acute pain following a musculoskeletal injury underwent a neuropsychological battery within 72 hours of injury. Follow up testing occurred within two weeks from the initial testing session when participants were pain free. Pain intensity was measured using the Visual Analog Scale (VAS). The neuropsychological battery consisted of the following tests: Digit Span (DS), Rey Auditory Verbal Learning Test (RAVLT), and Trail Making Test B (TMT-B). The DS was broken into two separate scores, the RAVLT four scores, and TMT-B one score. Seven paired samples t-tests were conducted using an adjusted alpha level of 0.007.
Results: Participants had significantly improved scores when pain free in DS forwards (p<0.007) and TMT-B (p<0.007). No significant difference was observed for the DS backward (p=0.023), RAVLT A1 (p=0.563), RAVLT sum A1 to A5 (p=0.953), RAVLT A6 (p=1.0), RAVLT recognition list A (p=0.009). These results suggest that immediate recall and complex attention may be diminished in individuals who experience acute pain due to a musculoskeletal injury.
Conclusions: Results from this study suggest acute pain from musculoskeletal injuries may disrupt executive function.
Relevance for patients: Patients should be aware that there may be cognitive changes after a musculoskeletal injury. Knowing which cognitive domains may be impaired during acute pain could impact clinical practice and further benefit patients suffering from pain and its associated symptoms.
[1] Sheu Y, Chen L, Hedegaard H. Sports- and Recreation-related In- jury Episodes in the United States, 2011-2014. Natl Health Stat Re- port 2016;1-12.
[2] Uitenbroek DG. Sports, exercise, and other causes of injuries: re- sults of a population survey. Res Q Exerc Sport 1996;67:380-385.
[3] Reddy BS. The epidemic of unrelieved chronic pain. The ethical, societal, and regulatory barriers facing opioid prescribing physi- cians. J Leg Med 2006;27:427-442.
[4] Manchikanti L, Helm S,2nd, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician 2012;15:ES9-ES38.
[5] Melzack R. Pain and the Neuromatrix in the Brain. J Dent Educ 2001;65:1378.
[6] Spenkelink C, Hutten MM, Hermens H, Greitemann BO. Assess- ment of activities of daily living with an ambulatory monitoring system: a comparative study inpatients with chronic low back pain and nonsymptomatic controls. Clin Rehabil 2002;16:16-26.
[7] Lezak MD, Howieson DB, Loring DW. Neuropsychological As- sessment,. 198 Madison Avenue, New York, New York, 10016: Oxford University Press; 2004.
[8] Lorist MM, Tops M. Caffeine, fatigue, and cognition. Brain Cogn 2003;53:82-94.
[9] Carter C. Cognition. Executive function. Am J Psychiatry 2000;157:3.
[10] Wang C, Shih C, Pesce C, Song T, Hung T, Chang Y. Failure to identify an acute exercise effect on executive function assessed by the Wisconsin Card Sorting Test. Journal of Sport and Health Sci- ence 2015;4:64-72.
[11] Gilbert SJ, Burgess PW. Executive function. Current Biology 2008;18:R110-R4.
[12] Moriarty O, McGuire BE, Finn DP. The effect of pain on cogni- tive function: A review of clinical and preclinical research. Prog Neurobiol 2011;93:385-404.
[13] Hutchison M, Comper P, Mainwaring L, Richards D. The Influ- ence of Musculoskeletal Injury on Cognition: Implications for Concussion Research. The American Journal of Sports Medicine 2011;39:2331-2337.
[14] Rubin DA. Imaging diagnosis and prognostication of hamstring in- juries. Am J Roentgenol 2012;199:525-533.
[15] Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle in- jury with amount of time lost from competition. Am J Roentgenol 2002;179:1621-1628.
[16] Kirkendall DT, Garrett Jr WE. Clinical perspectives regarding eccentric muscle injury. Clinical Orthopaedics and Related Re- search® 2002;403:S81-S9.
[17] Eccleston C CG. Psychological bulletin. Pain demands attention: A cognitive-affective model of the interruptive function of pain. American Psychological Association 1999;125:356.
[18] KeoghE, Moore DJ, Duggan GB, Payne SJ, Eccleston C. The dis- ruptive effects of pain on complex cognitive performance and ex- ecutive control. PLoS One 2013;8:e83272.
[19] Seminowicz DA, Davis KD. Pain enhances functional connectiv- ity of a brain network evoked by performance of a cognitive task. JNeurophysiol 2007;97:3651-3659.
[20] Alshelh Z, Marciszewski KK, Akhter R, Di Pietro F, Mills EP, Vickers ER, Peck CC, Murray GM, Henderson LA. Disruption of default mode network dynamics in acute and chronic pain states. NeuroImage: Clinical 2018;17:222-231.
[21] DA, Davis KD. Interactions of pain intensity and cognitive load: the brain stays on task. Cereb Cortex 2007;17:1412-1422.
[22] Glass JM, Williams DA, Fernandez-Sanchez M,KairysA, Barjola P, Heitzeg MM, Clauw DJ, Schmidt-Wilcke T. Executive Function in Chronic Pain Patients and Healthy Controls: Different Cortical Activation During Response Inhibition in Fibromyalgia. The Jour- nal of Pain 2011;12:1219-1229.
[23] Tracey J. The Emotional Response to the Injury and Rehabilitation Process. Journal of Applied Sport Psychology 2003;15:279-293.
[24] Riemann BL, Tray NC, Lephart SM. Unilateral Multiaxial Coordi- nation Training and Ankle Kinesthesia, Muscle Strength, and Pos- tural Control. J Sport Rehabil. 2003;12:13-30.
[25] Brunyé TT, Mahoney CR, Lieberman HR, Taylor HA. Caffeine modulates attention network function. Brain Cogn 2010;72:181- 188.
[26] Stewart AL, Hays RD, Ware JE,Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988;26:724-735.
[27] Hawker GA, Mian S, Kendzerska T, French M: Measures of adult pain. Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res 2011;63:S240-S52.
[28] Strauss, E., Sherman, E.M.S., Spreen, O. A Compendium of Neu- rospsychological Tests: Administration, norms and commentary,. New York: Oxford University Press; 2006.
[29] Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery. In ; 1985.
[30] Sullivan K, Deffenti C, Keane B. Malingering on the RAVLT: Part II. Detection strategies. Archives of Clinical Neuropsychology 2002;17:223-233.
[31] Messinis L, Tsakona I, Malefaki S, Papathanasopoulos P. Norma- tive data and discriminant validity of Rey’s Verbal Learning Test for the Greek adult population. Archives of Clinical Neuropsychology 2007;22:739-752.
[32] Berryman C, Stanton TR, Bowering KJ, Tabor A, McFarlane A, Moseley GL. Do people with chronic pain have impaired ex- ecutive function? A meta-analytical review. Clin Psychol Rev 2014;34:563-579.
[33] Etherton JL, Bianchini KJ, Ciota MA, Greve KW. Reliable Digit Span is Unaffected by Laboratory-Induced Pain Implications for Clinical Use. Assessment 2005;12:101-106.
[34] Etherton J. Cold pressor-induced pain does not impair WAIS-IV processing speed index or working memory index performance. Appl Neuropsychol Adult 2014;21:14-20.
[35] Gignac GE. The magical numbers 7 and 4 are resistant to the Flynn effect: No evidence for increases in forward or backward recall across 85 years of data. Intelligence 2015;48:85-95.
[36] Schmidt M. Rey Auditory-Verbal Leanring Test,. Los Angeles: Western Psychological Services.
[37] Tombaugh TN. Trail Making Test A and B: normative data strati- fied by age and education. Arch Clin Neuropsychol 2004;19:203- 214.
[38] Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluat- ing normed and standardized assessment instruments in psychol- ogy. Psychol Assess 1994;284.
[39] Etherton JL, Bianchini KJ, Greve KW, Heinly MT. Sensitivity and Specificity of Reliable Digit Span in Malingered Pain-Related Dis- ability. Assessment 2005;12:130-6.
[40] Stuss DT, Stethem LL, Poirier CA. Comparison of three tests of attention and rapid information processing across six age groups. Clin Neuropsychol 1987;1:139-52.