Caulfield Pain Management and Research Centre, Caulfield, Victoria, Australia.
School of Psychological Sciences, Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia.
Pain. 2018 Apr;159(4):644-655. doi: 10.1097/j.pain.0000000000001150.
Chronic pain is associated with reduced efficiency of cognitive performance, and few studies have investigated methods of remediation. We trialled a computerised cognitive training protocol to determine whether it could attenuate cognitive difficulties in a chronic pain sample. Thirty-nine adults with chronic pain (mean age = 43.3, 61.5% females) were randomised to an 8-week online course (3 sessions/week from home) of game-like cognitive training exercises, or an active control involving watching documentary videos. Participants received weekly supervision by video call. Primary outcomes were a global neurocognitive composite (tests of attention, speed, and executive function) and self-reported cognition. Secondary outcomes were pain (intensity; interference), mood symptoms (depression; anxiety), and coping with pain (catastrophising; self-efficacy). Thirty participants (15 training and 15 control) completed the trial. Mixed model intention-to-treat analyses revealed significant effects of training on the global neurocognitive composite (net effect size [ES] = 0.43, P = 0.017), driven by improved executive function performance (attention switching and working memory). The control group reported improvement in pain intensity (net ES = 0.65, P = 0.022). Both groups reported subjective improvements in cognition (ES = 0.28, P = 0.033) and catastrophising (ES = 0.55, P = 0.006). Depression, anxiety, self-efficacy, and pain interference showed no change in either group. This study provides preliminary evidence that supervised cognitive training may be a viable method for enhancing cognitive skills in persons with chronic pain, but transfer to functional and clinical outcomes remains to be demonstrated. Active control results suggest that activities perceived as relaxing or enjoyable contribute to improved perception of well-being. Weekly contact was pivotal to successful program completion.
慢性疼痛与认知表现效率降低有关，很少有研究调查补救方法。我们试用了一种计算机认知训练方案，以确定它是否可以减轻慢性疼痛样本的认知困难。39 名慢性疼痛成年人（平均年龄=43.3，61.5%为女性）被随机分配到 8 周的在线课程（每周 3 次，在家中进行），内容为游戏式认知训练练习，或主动控制组，涉及观看纪录片视频。参与者每周通过视频通话接受监督。主要结果是全球神经认知综合测试（注意力、速度和执行功能测试）和自我报告的认知。次要结果是疼痛（强度；干扰）、情绪症状（抑郁；焦虑）和应对疼痛（灾难化；自我效能）。30 名参与者（15 名训练组和 15 名对照组）完成了试验。混合模型意向治疗分析显示，训练对全球神经认知综合测试有显著影响（净效应大小[ES]为 0.43，P=0.017），这主要归因于执行功能表现的改善（注意力转换和工作记忆）。对照组报告疼痛强度改善（净 ES=0.65，P=0.022）。两组均报告认知（ES=0.28，P=0.033）和灾难化（ES=0.55，P=0.006）的主观改善。抑郁、焦虑、自我效能和疼痛干扰在两组中均无变化。本研究初步证明，监督认知训练可能是增强慢性疼痛患者认知技能的可行方法，但功能和临床结果的转移仍有待证明。主动对照组的结果表明，被认为放松或愉快的活动有助于改善幸福感的认知。每周的联系是成功完成计划的关键。
