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The Role of Cognitive Content and Cognitive Processes in Chronic Pain: An Important Distinction?

Jensen, Mark, P., PhD*; Thorn, Beverly, E., PhD; Carmody, James, PhD; Keefe, Francis, J., PhD§; Burns, John, W., PhD

The Clinical Journal of Pain: May 2018 - Volume 34 - Issue 5 - p 391–401
doi: 10.1097/AJP.0000000000000559
Original Articles

Objectives: Pain-related cognitive content (what people think about pain) and cognitive processes (how people think about pain; what they do with their pain-related thoughts) and their interaction are hypothesized to play distinct roles in patient function. However, questions have been raised regarding whether it is possible or practical to assess cognitive content and cognitive process as distinct domains. The aim of this study was to determine the extent to which measures that seem to assess mostly pain-related cognitive content, cognitive processes, and content and process, are relatively independent from each other and contribute unique variance to the prediction of patient function.

Materials and Methods: Individuals with chronic low back pain (N=165) participating in an ongoing RCT were administered measures of cognitions, pain, and function (depressive symptoms and pain interference) pretreatment.

Results: Analyses provided support for the hypothesis that cognitive content and cognitive process, while related, can be assessed as distinct components. However, the measure assessing a cognitive process—mindfulness—evidenced relatively weak associations with function, especially compared with the stronger and more consistent findings for the measures of content (catastrophizing and self-efficacy).

Discussion: The results provide preliminary evidence for the possibility that mindfulness could have both benefits and costs. Research to evaluate this possibility is warranted.

*Department of Rehabilitation Medicine, University of Washington, Seattle, WA

Department of Psychology, University of Alabama, Tuscaloosa, AL

Department of Medicine, University of Massachusetts Medical School, Worcester, MA

§Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC

Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL

Supported (in part) through a Patient-Centered Outcomes Research Institute (PCORI) Award (no. 941) ( All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or Methodology Committee. This work was also supported in part by grants from the National Institutes of Health, National Institute of Nursing Research, Bethesda, MD (grant #R01 NR013910), the National Institute of Child Health and Human Development, Bethesda, MD (grant #R01 HD070973), and the National Center for Complimentary and Integrative Health, Bethesda, MD (grant #R01 AT008336). The authors declare no conflict of interest.

Reprints: Mark P. Jensen, PhD, Department of Rehabilitation Medicine, University of Washington, P.O. Box 359612, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104 (e-mail:

Received February 16, 2017

Received in revised form July 3, 2017

Accepted August 15, 2017

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