Baker Katharine S, Gibson Stephen, Georgiou-Karistianis Nellie, Roth Robert M, Giummarra Melita J
*Caulfield Pain Management and Research Centre, Caulfield †School of Psychological Sciences, Monash University ‡National Ageing Research Institute, Parkville, Vic, Australia §Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Clin J Pain. 2016 Aug;32(8):673-80. doi: 10.1097/AJP.0000000000000313.
People with chronic pain may experience impairments in high-level cognitive skills, particularly executive functions. Such impairments are not adequately measured in most clinical pain management settings yet could be a key influence on everyday functioning. We administered a well-validated, well-normed self-report measure to determine which aspects of executive functioning are compromised in the daily experience of patients with chronic pain, and whether these are associated with pain severity, medications, and mood.
Sixty-three patients attending a multidisciplinary pain management clinic, and 66 pain-free age-matched and sex-matched controls, completed the Behavior Rating Inventory of Executive Function, Adult version (BRIEF-A). The BRIEF-A measures 9 aspects of executive function: Inhibit, Shift, Emotional Control, Initiate, Self-Monitor, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials. Patients completed a battery of mood and pain-related measures.
Profile analysis revealed that patients with chronic pain reported significantly greater overall executive function impairments than controls. The patients showed greatest impairments on Working Memory and Emotional Control subscales, with more than half scoring in the clinically elevated range. A significant proportion of the variance in these scores was explained by total medication detriment (but not opioids alone), negative emotional states, and pain interference. Pain intensity and duration were not strong predictors of reported executive dysfunction.
Multiple factors impact on self-reported executive problems in this population. Specific deficits in Working Memory and Emotional Control have implications for patient engagement with treatment, and retention of information provided in therapy. A screening tool like the BRIEF-A may be useful in pain management settings.
慢性疼痛患者可能在高级认知技能方面存在损害，尤其是执行功能。在大多数临床疼痛管理环境中，此类损害未得到充分评估，但可能对日常功能产生关键影响。我们采用了一种经过充分验证且有良好常模的自我报告测量方法，以确定执行功能的哪些方面在慢性疼痛患者的日常体验中受到损害，以及这些方面是否与疼痛严重程度、药物治疗和情绪相关。
63名在多学科疼痛管理诊所就诊的患者以及66名年龄和性别匹配的无疼痛对照者完成了成人版执行功能行为评定量表（BRIEF - A）。BRIEF - A测量执行功能的9个方面：抑制、转换、情绪控制、启动、自我监控、工作记忆、计划/组织、任务监控和材料组织。患者完成了一系列情绪和疼痛相关的测量。
轮廓分析显示，慢性疼痛患者报告的总体执行功能损害明显大于对照组。患者在工作记忆和情绪控制分量表上表现出最大损害，超过一半的患者得分处于临床升高范围。这些分数的很大一部分变异可由总药物损害（而非仅阿片类药物）、负性情绪状态和疼痛干扰来解释。疼痛强度和持续时间并非报告的执行功能障碍的有力预测因素。
多种因素影响该人群自我报告的执行问题。工作记忆和情绪控制方面的特定缺陷对患者参与治疗以及保留治疗中提供的信息有影响。像BRIEF - A这样的筛查工具在疼痛管理环境中可能有用。
