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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 17, Issue 1

Issues

The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy

Marcus Schiltenwolf
  • Department of Orthopaedic Surgery and Traumatology, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Michael Akbar
  • Department of Orthopaedic Surgery and Traumatology, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Eva Neubauer
  • Department of Orthopaedic Surgery and Traumatology, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Simone Gantz
  • Department of Orthopaedic Surgery and Traumatology, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Herta Flor
  • Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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  • De Gruyter OnlineGoogle Scholar
/ Andreas Hug
  • Spinal Cord Injury Center, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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  • De Gruyter OnlineGoogle Scholar
/ Haili Wang
  • Corresponding author
  • Department of Orthopaedic Surgery and Traumatology, University Hospital of Heidelberg, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.07.019

Abstract

Objectives

Little is known about the affected cognitive problems in chronic low back pain patients. For this patient cohort research mostly focused on memory of pain, rather than cognitive difficulties related to pain. Chronic pain may be associated with specific (yet undefined) cognitive deficits that affect everyday behaviour. We set out to compare the cognitive function of patients with chronic low back pain (cLBP) in the course of multidisciplinary pain treatments before and after therapy.

Methods

Thirty-three patients with cLBP and 25 healthy controls between 20 and 70 years were recruited into the study. The inclusion criteria for patients were: (1) a history of at least 12 weeks of chronic myofascial low back pain without radicular pain sensation before enrolment; (2) grade II and higher chronicity according to von Korff; (3) no opioid medication. The patients recruited had a mean pain duration of 7.13 ± 7.16 years and reported a mean pain intensity of 6.62 ± 2.04 (visual analogue score, VAS). Their mean back function according to the Funktionsfragebogen Hannover (FFbH, a questionnaire comparable with the Health Assessment Questionnaire) was 52.39 ± 20.23%.

At three time points (before therapy, 3 weeks and 6 months after therapy) the study subjects were assessed prospectively with a battery of visual memory tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). These included choice reaction time (CRT), pattern recognition memory (PRM) and spatial span (SSP). In parallel, the Trail-Making Test (TMT-A, TMT-B) and the Wechsler Adult Intelligence Scale (WAIS-III) were used to evaluate intelligence and cognitive flexibility.

Results

At the beginning of MDPT (T1), it took patients with cLBP significantly longer than HC to complete TMT-A (38.29 ± 19.99 s vs 30.25 ± 14.19 s, p = 0.047) and TMT-B (72.10 ± 26.98 s vs 55.99 ± 22.14 s, p = 0.034). There were no significant differences between patients and HC in CRT, PRM and SSP. Three weeks (T2) and 6 months (T3) after MDPT, TMT-A reaction time of patients significantly improved by 6.5 s and 8.1 ms (38.3 ±19.9 s vs 31.8 ±12.3 s, p = 0.02 and 31.8 ± 12.3 s vs 30.2 ± 8.9 s, p = 0.021, respectively). The patients’ working memory was also better 6 months after MDPT (48.8 ± 11.1% at T1, 51.2 ±11.9% at T2, 57.1 ±10.9% at T3, p = 0.008). Significant correlations among pain, depression/anxiety, medication and neuropsychological tests were found.

Conclusions

These findings show that patients with cLBP have slowed speeds of information processing and working memory, but no alteration in attention and recognition memory. There are clearly interactions of cognitive function with pain, depression, anxiety, and medication. MDPT may improve the impaired cognitive function of patients with cLBP.

Implication

Health professionals should contemplate the results from this study when planning therapy strategies especially when prescribing pain medications such opioids to patients with chronic low back pain.

Keywords: Chronic low back pain; Cognitive function; Multidisciplinary pain therapy

References

  • [1]

    Eccleston C. Chronic pain and attention: a cognitive approach. BrJ Clin Psychol 1994;33 (Pt 4):535–47.CrossrefGoogle Scholar

  • [2]

    Katz RS, Heard AR, Mills M, Leavitt F. The prevalence and clinical impact of reported cognitive difficulties (fibrofog) in patients with rheumatic disease with and without fibromyalgia. J Clin Rheumatol 2004;10:53–8.PubMedCrossrefGoogle Scholar

  • [3]

    Apkarian AV, Sosa Y, Krauss BR, Thomas PS, Fredrickson BE, Levy RE, Harden RN, Chialvo DR. Chronic pain patients are impaired on an emotional decisionmaking task. Pain 2004;108:129–36.PubMedCrossrefGoogle Scholar

  • [4]

    Grisart JM, Van der Linden M. Conscious and automatic uses of memory in chronic pain patients. Pain 2001;94:305–13.PubMedCrossrefGoogle Scholar

  • [5]

    Dick B, Eccleston C, Crombez G. Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeleta pain patients. Arthritis Rheum 2002;47:639–44.CrossrefGoogle Scholar

  • [6]

    Jamison RN, Sbrocco T, Parris WC. The influence of problems with concentration and memory on emotional distress and daily activities in chronic pain patients. IntJ Psychiatry Med 1988;18:183–91.Google Scholar

  • [7]

    McCracken LM, Iverson GL. Predicting complaints of impaired cognitive functioning in patients with chronic pain. JPain Symptom Manage 2001;21:392–6.CrossrefGoogle Scholar

  • [8]

    Demoulin C, Grosdent S, Capron L, Tomasella M, Somville PR, Crielaard JM, Vanderthommen M. Effectiveness of a semi-intensive multidisciplinary out patient rehabilitation program in chronic low back pain. Joint Bone Spine 2010;77:58–63.PubMedCrossrefGoogle Scholar

  • [9]

    Lefebvre MF. Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients. J Consult Clin Psychol 1981;49:517–25.CrossrefPubMedGoogle Scholar

  • [10]

    Michiels V, Cluydts R, Fischler B. Attention and verbal learning in patients with chronic fatigue syndrome. J Int Neuropsychol Soc 1998;4:456–66.CrossrefPubMedGoogle Scholar

  • [11]

    Servatius RJ, Tapp WN, Bergen MT, Pollet CA, Drastal SD, Tiersky LA, Desai P, Natelson BH. Impaired associative learning in chronic fatigue syndrome. Neuroreport 1998;9:1153–7.CrossrefPubMedGoogle Scholar

  • [12]

    Vercoulen JH, Bazelmans E, Swanink CM, Galama JM, Fennis JF, van der Meer JW, Bleijenberg G. Evaluating neuropsychological impairment in chronic fatigue syndrome. JClin Exp Neuropsychol 1998;20:144–56.CrossrefGoogle Scholar

  • [13]

    Etherton JL, Bianchini KJ, Heinly MT, Greve KW. Pain, malingering, and performance on the WAIS-III Processing Speed Index. J Clin Exp Neuropsychol 2006;28:1218–37.CrossrefPubMedGoogle Scholar

  • [14]

    Weiner DK, Rudy TE, Morrow L, Slaboda J, Lieber S. The relationship between pain, neuropsychological performance, and physica function in community-dwelling older adults with chronic low back pain. Pain Med 2006;7: 60-70.CrossrefGoogle Scholar

  • [15]

    Luoto S, Taimela S, Alaranta H, Hurri H. Psychomotorspeed in chronic low-back pain patients and healthy controls: construct validity and clinical significance of the measure. Percept Mot Skills 1998;87:1283–96.CrossrefPubMedGoogle Scholar

  • [16]

    Luoto S, Taimela S, Hurri H, Alaranta H. Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up.Spine (Phila Pa 1976) 1999;24:255–61.CrossrefGoogle Scholar

  • [17]

    Lehrl S, Triebig G, ischer B. Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence. Acta Neurol Scand 1995;91:335–45.CrossrefPubMedGoogle Scholar

  • [18]

    Wechsler D, editor. Wechsler Adult intelligence Scale-III. San antonio, TX: The Psychological Corporation; 1997.Google Scholar

  • [19]

    Lezak MD, Howieson DB, Loring DW, editors. Neuropsychological Assessment. New York: Oxford University Press; 2004.Google Scholar

  • [20]

    Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P. Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 1994;5:266–81.PubMedGoogle Scholar

  • [21]

    Luciana M. Practitioner review: computerized assessment of neuropsychological function in children: clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB). J Child Psychol Psychiatry 2003;44:649–63.CrossrefPubMedGoogle Scholar

  • [22]

    Jorge LL, Gerard C, Revel M. Evidences of memorydys function and maladaptive coping in chronic low back pain and rheumatoid arthritis patients: challenges for rehabilitation. Eur J Phys Rehabil Med 2009;45:469–77. Epub.2009 Nov 24.Google Scholar

  • [23]

    Roth RS, Geisser ME, Theisen-Goodvich M, Dixon PJ. Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain. Arch Phys Med Rehabil 2005;86:1147–54.PubMedCrossrefGoogle Scholar

  • [24]

    Sjogren PI, Thomsen AB, Olsen AK. Impaired neuropsychological performance in chronic nonmalignant pain patients receiving long-term oral opioid therapy. J Pain Symptom Manage 2000;19:100–8.CrossrefPubMedGoogle Scholar

  • [25]

    Claypoole KH, Noonan C, Mahurin RK, Goldberg J, Erickson T, Buchwald D. A twin study of cognitive function in chronic fatigue syndrome: the effects of sudden illness on set. Neuropsychology 2007;21:507–13.CrossrefGoogle Scholar

About the article

Am Rebgarten 18, 69221 Dossenheim, Germany


Received: 2017-03-07

Revised: 2017-07-18

Accepted: 2017-07-25

Published Online: 2017-10-01

Published in Print: 2017-10-01


Ethical issues: All participants gave their written, informed consent to take part in the study and for their data to be published anonymously. The study was approved by the ethics committee of the University Hospital of Heidelberg, Germany and funded by the research fund of the Department of Orthopaedic Surgery and Traumatology of the University of Heidelberg.

Conflict of interest: None declared.


Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 273–278, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.07.019.

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