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The Relationship between Chronic Pain and Neurocognitive Function: A Systematic Review

Higgins, Diana M. PhD; Martin, Aaron M. PhD; Baker, Dewleen G. MD; Vasterling, Jennifer J. PhD; Risbrough, Victoria PhD
The Clinical Journal of Pain: Post Acceptance: July 17, 2017
doi: 10.1097/AJP.0000000000000536
Dochead: PDF Only


Understanding the relationship between chronic pain and neurocognition has important implications for the assessment and treatment of pain. This paper provides an overview of the current literature examining the neurocognition-chronic pain relationship and suggests future avenues of research, along with a discussion of clinical implications of the literature findings. Consideration of potential moderators and mediators of this relationship, as well as a brief discussion of the importance of future research in special populations at particular risk for these problems, are also a focus of this paper.


This systematic review summarizes the findings of clinical studies in which neurocognitive performance was measured in chronic pain samples. A literature search led to the inclusion of 53 articles in the review.


Studies of neurocognitive performance in clinical chronic pain samples support a relationship between chronic pain and neurocognitive abnormalities, particularly on tests of memory, attention, and processing speed, with mixed data regarding executive functioning.


Several factors may moderate or mediate the relationship between chronic pain and neurocognitive functioning, including mood symptoms, medication side effects, and intensity and/or chronicity of pain. Limitations in the literature include a paucity of methodologically rigorous studies controlling for confounding variables (e.g., opioid analgesia) and a limited number of studies examining the relationship between chronic pain and traumatic brain injury (a potential precipitant of both pain and neurocognitive impairment). Nonetheless, findings from the existing literature have significant clinical implications, including for populations with heightened risk of both pain and neurocognitive disorders.

Research Funding: This work was supported in part by the Naval Medical Research Center's Advanced Medical Development program (Naval Medical Logistics Command Contract # N62645-11-C-4037, for MRS II).

Disclaimer: The opinions expressed here are those of the authors and do not represent the official policy or position of the US Department of Veterans Affairs.

ACT, Auditory Consonant Trigram; AIMS, Arthritis Impact Measurement Scales; BWCT, Bourdon-Wiersman Cancellation Task; CERAD, Consortium to Establish a Registry for Alzheimer’s Disease 10-item List; CLBP, Chronic Low Back Pain; COWA, Controlled Oral Word Association; CRT= continuous/choice reaction time test; CTRM, Camden Topographical Recognition Memory test; CVLT, California Verbal Learning Test; DFT, Design Fluency Test; DSP, Distal symmetric polyneuropathy; DSST, Digit-Symbol Subtest; DVT, Digit Vigilance Test; EFT, Embedded Figures Test; EWT, Eight Word Test; FCRTT, Four Choice Reaction Time Task; FTT=finger tapping test; HA, Headache; HRNB, Halstead-Reitan Neuropsychological Battery; KCIT, Knox’s Cube Imitation Test; LFT, Letter Fluency Test; LRRT, Logical Reasoning Reaction Task; LS, Letter Number Sequencing; MMSE=mini mental status exam; MPI-PS, Multidimensional Pain Inventory – Pain Severity; MSIT, Multisource Interference Test; MST, Memory Search Task; MT, Manikin Test; NCSE, Neurobehavioral Cognitive Screening Exam; NRS, Numerical Rating Scale; OSPAN, Operation Span Task; PASAT= Paced Auditory Serial Addition Task; PVT, Psychomotor Vigilance Test; RA, Rheumatoid Arthritis; RAVLT, Rey Auditory Visual Learning Test; RBANS, Repeated Battery for the Assessment of Neuropsychology Status; RBMT, Rivermead Behavioral Memory Test; ROCFT, Rey-Osterrieth Complex Figure Test; RST, Reading Span Test; RVDLT, Rey Visual Design Learning Test; SCL-90-R, Symptom Checklist-90 Revised; SDLT, Symbol-Digit Learning Test; SDMT, Symbol Digit Modalities Test; SILVT, Shipley Institute of Living Vocabulary Test; SST, Spatial Span Test; TEA, Test of Everyday Attention; VAS, Visual analogue scale; WAIS-III, 3rd Edition; WAIS-R, Wechsler Adult Intelligence Scale, Revised; ; WASI, Wechsler Abbreviated Scale of Intelligence; WCST, Wisconsin Card Sorting Test; WMS-III, 3rd edition; WMS-R, Wechsler Memory Scale Revised.

COI: No conflicts of interest.

Reprints: Diana M. Higgins, PhD. VA Boston Healthcare System, 150 South Huntington Avenue, 116-B-2, Boston, MA 02130 (e-mail:

Received September 9, 2016

Accepted July 3, 2017

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