Chronic pain patients are impaired on an emotional decision-making task

Apkarian, Vania A.; Sosa, Yamaya; Krauss, Beth R.; Thomas, Sebastian P.; Fredrickson, Bruce E.; Levy, Robert E.; Harden, Norman R.; Chialvo, Dante R.

doi:10.1016/j.pain.2003.12.015

Cited by 536Musculoskeletal pain and rehabilitationPain Mechanisms and TreatmentsNeural and Behavioral Psychology Studies

Chronic pain patients are impaired on an emotional decision-making task

Apkarian, Vania A., Sosa, Yamaya, Krauss, Beth R., Thomas, Sebastian P., Fredrickson, Bruce E., Levy, Robert E., Harden, Norman R., Chialvo, Dante R.·2004·Pain

DOI 10.1016/j.pain.2003.12.015

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Abstract

Chronic pain can result in anxiety, depression and reduced quality of life. However, its effects on cognitive abilities have remained unclear although many studies attempted to psychologically profile chronic pain. We hypothesized that performance on an emotional decision-making task may be impaired in chronic pain since human brain imaging studies show that brain regions critical for this ability are also involved in chronic pain. Chronic back pain (CBP) patients, chronic complex regional pain syndrome (CRPS) patients, and normal volunteers (matched for age, sex, and education) were studied on the Iowa Gambling Task, a card game developed to study emotional decision-making. Outcomes on the gambling task were contrasted to performance on other cognitive tasks. The net number of choices made from advantageous decks after subtracting choices made from disadvantageous decks on average was 22.6 in normal subjects (n = 26), 13.4 in CBP patients (n = 26), and -9.5 in CRPS patients (n = 12), indicating poor performance in the patient groups as compared to the normal controls (P < 0.004). Only pain intensity assessed during the gambling task was correlated with task outcome and only in CBP patients (r = -0.75, P < 0.003). Other cognitive abilities, such as attention, short-term memory, and general intelligence tested normal in the chronic pain patients. Our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden, situations.

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In a previous study, CRPS patients have shown a special cognitive deficit with impaired emotional decision-making.
“In a previous study, CRPS patients have shown a special cognitive deficit with impaired emotional decision-making [41].”
From Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy (2019) · cites this paper as [41]

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Authors: Apkarian, V. A., Sosa, Y., Krauss, B. R., Thomas, S. P., Fredrickson, B. E., Levy, R. E., Harden, N. R., & Chialvo, D. R.
Affiliations: Northwestern University (US)
SUNY Upstate Medical University (US)
ORCID: Chialvo, Dante R.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004-03
Volume: 108
Issue: 1
Pages: 129-136
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2003.12.015
OpenAlex: W2144854156
Cited by: 536
References: 37
Citations by year: 2026: 14 · 2025: 23 · 2024: 21 · 2023: 21 · 2022: 15 · 2021: 31 · 2020: 24 · 2019: 18 · 2018: 32 · 2017: 31 · 2016: 24 · 2015: 28 · 2014: 44 · 2013: 35 · 2012: 31
FWCI: 9.21
Type: journal article
Language: en
Open access: closed
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Neurological Disorders and Stroke (NS35115, R01NS035115)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords: chronic pain, emotional decision-making, Iowa Gambling Task, chronic back pain, complex regional pain syndrome, cognitive impairment, pain intensity, risk assessment
MeSH terms: Adult, Back Pain, Chronic Disease, Cognition, Decision Making, Emotions, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Complex Regional Pain Syndromes

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Chronic pain patients are impaired on an emotional decision-making task

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