The interference of experimental pain and cognition in patients suffering from chronic pain

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Acute pain is an important warning signal for our body. It signals tissue damage and allows the rapid withdrawal from the source of danger to protect ourselves. Pain perception and pain processing are therefore prioritized over other, less relevant cognitive processes, thus leading to an interference between pain processing and cognition. This so called interruptive function of pain is physiologically beneficial in acute pain, but has lost its protective function in chronic pain. However, patients suffering from chronic pain frequently report pain-induced cognitive disturbances, particularly attention and memory deficits, that impair their quality of life. To date, the interruptive function of pain has been almost entirely investigated in healthy samples, giving first insights into the neural mechanisms underlying the interference of pain and cognition. Unfortunately, well-conducted, experimental studies about the detrimental effects of pain in patients suffering from chronic pain are lacking. It is therefore the aim of the planned study to investigate the interruptive effect of experimental pain in patients suffering from chronic low back pain and patients suffering from chronic migraine and to compare them to healthy controls. We aim to identify psychological and neuronal predictors of enhanced or decreased interference of pain and cognition. The interruptive effect of pain will be investigated using a visual categorization task and a memory task, in which painful electrical stimuli will be applied to the lower back and the forehead concurrently to the presentation of neutral images. We expect that patients suffering from chronic pain will show greater detrimental effects of concurrent painful stimulation on task performance due to the constant activation of the pain system and the resulting changes in psychological (e.g. attentional biases, pain-related anxiety) and neural processing. Here, we want to investigate whether pain patients show an enhanced interruptive function of pain in general or whether the effects of experimental pain are augmented at the body site (lower back or head) that is affected by the chronic pain condition. In addition to behavioral and physiological data, we will acquire neural data using (functional) magnetic resonance imaging (fMRI; morphology and resting state connectivity) to identify psychological and/or neurobiological markers of a heightened vulnerability to the detrimental effects of pain. Such markers could, in the long-term, be used to identify patients prone to the interruptive effect of pain and to optimize their therapeutic treatment within a multimodal pain therapy.