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

Chronic pain patients are impaired on an emotional decision-making task,10.1016/j.pain.2003.12.015,Pain,A. Vania Apkarian,Yamaya Sosa,Beth R. Krauss,P

Chronic pain patients are impaired on an emotional decision-making task   (Citations: 96)
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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.
Journal: Pain , vol. 108, no. 1, pp. 129-136, 2004
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    • ...the Iowa Gambling Task) [10] in patients suffering from complex region pain syndrome type I (CRPS I) or chronic back pain similarly to patients with frontal cortex lesions...
    • ...Enhanced pain perception [13-15] has been shown to be associated with over-expression of the NR2B subunit of the NMDA receptor and morphological reorganization in the anterior cingulate cortex [10]...
    • ...A further consideration concerns the evidence that the current data from 7-day treated SNI rats do not seem to be consistent with data obtained in patients suffering from neuropathic pain, in whom atrophy of the limbic prefrontal cortex was reported [10]...
    • ...Several previous studies have reported that the PL/IL cortex, which corresponds to the dorsal-lateral prefrontal cortex in humans, plays a crucial role in pain processing [10,89-93], and emerging imaging studies show that this brain region is involved in pain inhibition in humans [93]...

    Vito de Novelliset al. The blockade of the transient receptor potential vanilloid type 1 and ...

    • ... Apkarian and colleagues reported that chronic pain patients were impaired on an emotional decision task, a test that has been directly linked to functional properties of the frontal lobe ...

    Marijtje L. A. Jongsmaet al. Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Pat...

    • ... It is worth noting that the acceptance rates were higher in the Pain condition irrespectively of the fairness of the offer, suggesting that the perception of pain favours the emergence of a maximizing behavior. Such behavior allows subjects to make choices aimed at achieving the highest possible gain. Interestingly, this effect is reminiscent of what found in chronic back pain (CBP) patients playing the Iowa Gambling Task ...

    Alessandra Manciniet al. Suffering Makes You Egoist: Acute Pain Increases Acceptance Rates and ...

    • ...Some studies reported an impact of working memory and executive functions on IGT performance (Bechara & Martin, 2004; Dretsch & Tipples, 2008; Hinson, Jameson, & Whitney, 2002; Labudda et al, 2009; Sinz, Zamarian, Benke, Wenning, & Delazer, 2008) but others did not (Apkarian et al, 2004; Bechara, Damasio, Tranel, & Anderson, 1998; Cavedini et al, 2002a, 2002b; Lehto & Elorinne, 2003; Whitney, Fastenau, Evans, & Lysaker, 2004)...

    Kirsten Labuddaet al. Alterations of decision making and underlying neural correlates after ...

    • ...Furthermore, additional brain areas are involved in processing the emotional [10] and cognitive [11] aspects of the pain experience, and their activation is dependent on the particular set of circumstances for each individual [6]...

    Simona Savaet al. Challenges of functional imaging research of pain in children

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