Chronic pain and cognition

With chronic pain of various types including migraine and fibromyalgia-But also things like allodynia neuropathic pain- I am well aware that pain impacts our memory and cognition. My main theory being that pain takes up space in the brain leaving less space and energy for your memory, comprehension and attention.

We have various problem with memory when it comes to chronic pain. From processing speed to working memory. From things like “problems when referring to films and books (61%), forgetfulness (44%), problems performing everyday tasks (38%) and in everyday conversations (38%) (Muñoz and Esteve, 2005)” (Study)

Experiencing and managing pain draws on cognitive resources, limiting how they can be used for other processes (Phelps et al., 2021). In particular, memory systems are vulnerable to impact, with research demonstrating that memory is susceptible to pain, fatigue, medications, lack of sleep, and chronic health problems (Anggraini, 2023, Segura-Jimenez et al., 2016)… When resources are limited due to other factors such as pain, our memory systems are unable to work as effectively as they would otherwise. Sciencedirect

Which succinctly states, yeah, pain and other factors adjacent to pain (fatigue, medications, insomnia, comorbid conditions) we have less resources for our memory systems.

The main problems with research of this sort is comorbid conditions associated with chronic pain, such as, sleep related issues, fatigue and other concerns as well as other chronic illness that affect memory and cognition.

Chronic Pain

Attention

Our attention is our directed consciousness. Our capacity to process information in that specific direction for a specific duration.

Commonly, when it comes to chronic pain and attention with a moderate level of functional/tolerable pain, I say distract the brain by focusing our attention, which then decreases our Perception of pain. Other times, when pain is intolerable/non-functional it Is the attention.

1.  There is an overlap between the attention matrix and the pain pathways in our brains. “…continued painful stimuli impact attentional control mechanisms required to remove task-irrelevant stimuli, resulting in decreased task performance”.
2. Adults can engage in cognitively demanding tasks to distract from pain to some extent. Which I think most of us are familiar with. Pain sensitivity is then decreased with engagement of attention and use of distractions. This not as true in older adults.
3. Depressed and/or anxiety can affect perception of pain and attention.
4. 2019 study on fibromyalgia showed a decreased accuracy on attention switching and divided tasks.

I know we are mostly aware of the uses of attention to distract our brains from pain to the extent we can. I wasn’t aware this decreased with age. I was very aware this was affected by the onset of depression, however. I was also aware fibromyalgia affects divided tasks and in fact there was research on multi-tasking suggesting with fibromyalgia we should focus on one task at a time.

Memory

Working memory is where we process and manipulate small amounts of information for a short duration in and out of the long-term memory. That along with short-term memory and long term memory retrieval of information, I would say are what I have the most issue with. Certainly, in a work environment where focus is necessary for long durations.

1. The hippocampus in the brain is associated with emotional stressors and with long-term explicit memory formation. Studies have shown a decreased volume in the hippocampus in chronic pain.
2. The amygdala is quite vital for learning. “The basolateral amygdala is activated in the presence of glucocorticoid, which impacts memory consolidation. Furthermore, working memory performance and retrieval are impaired with high glucocorticoid levels (Roozendaal et al., 2006). Involvement of the amygdala in chronic pain has now been shown in human studies and animal models for chronic pain, eliciting the influence of dorsal horn (DH) neuron excitation and the interaction between the amygdala and the mPFC (Neugebauer et al., 2004; Ji et al., 2010).”
3. There has been a lot of research to show that chronic pain adversely affects “working memory, recall, and recognition memory.”
4.  With chronic pain we often report “poor memory, recall, and concentration in their daily activities” 
5. Implicit memory (long-term memory that operates unconsciously- automatic and includes things like skills and habits) is less likely to be affected by pain owing to its very nature.

Strangely enough that last point about implicit memory has been affected in me in times of more intense pain at work. Where I will be doing a habitual task and mess it up- forget the order, do it in the wrong order, simple things like that.

Processing, Executive Functioning, and Decision Making

1. “Executive function is a set of neurological processes that assist with complex cognitive functions such as planning, organization, thought control, self-regulation, goal-directed actions, initiation, and analyses of actions” Gray matter reduction is seen age-related cognitive decline and impairs executive functioning and decreases processing speed. The age-related gray matter changes are sped up in chronic pain syndromes.
2. When it comes to executive functioning the type of pain matters. While it is impacted in fibromyalgia there is no correlation seen in neuropathies and chronic musculoskeletal pain (Grisart and Van der Linden, 2001; Verdejo-García et al., 2009).
3. “Perception, processing speed, executive functioning, and decision making are studied in patients with chronic pain and have demonstrated that pain adversely affects perceptual learning and emotional decision making” (Grisart and Van der Linden, 2001; Apkarian et al., 2004; Barnhart et al., 2019).
4.  Emotional decision-making quite a bit impacted in people with chronic lower back pain than people with CPRS (Apkarian et al., 2004)

Poor executive function, by the way, is to blame for all the times you want to say potato and say pickle, so there is that. That whole (name as many animals as you can in one minute or name as many names that start with the letter Q in one minute sort of deal). Chronic pain also competes for a whole lot of the brains recourses that we need for the things like executive functions.

Fibromyalgia

130 patients with fibromyalgia syndrome and 111 pain-free subjects with an average age of 54.96 years study in 2024.

Evaluation of Cognitive Performance in Patients with Fibromyalgia Syndrome: A Case-Control Study stated that with fibromyalgia pain objective cognitive differences are beyond mood (depression, anxiety) and sleep. Subjects performed worse on selective attention, long-term visual memory, processing speed, and inhibitory control after controlling for mood and sleep factors. The working memory and our ability to plan were not as readily affected.

I just wanted to add this specific study because it specifies that cognitive performance is affected regardless and outside of depression, anxiety and poor quality sleep. Which are factors that all impact our cognitive performance as well.

Source: Cognition and Pain: A Review

Evaluation of Cognitive Performance in Patients with Fibromyalgia Syndrome: A Case-Control Study

That feeling: Altschmerz