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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§,∥

doi: 10.1097/AJP.0000000000000536
Review Articles

Objective: Understanding the relationship between chronic pain and neurocognition has important implications for the assessment and treatment of patient experiencing 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.

Methods: 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.

Results: 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.

Discussion: 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 (eg, 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.

*Anesthesiology, Critical Care and Pain Medicine Service/Research Service

Psychology Service and National Center for PTSD, VA Boston Healthcare System

Department of Psychiatry, Boston University School of Medicine, Boston, MA

James A. Haley Veterans’ Hospital, Tampa, FL

§VA San Diego Healthcare System

Department of Psychiatry, University of California San Diego, San Diego, CA

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.

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), San Diego, CA. The authors declare no conflict 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

Received in revised form June 21, 2017

Accepted July 3, 2017

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