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Patients with chronic pain lack somatic markers during decision-making
Nicolas-Andreas Elvemo1, Kristian Bernhard Nilsen2, Nils Inge Landrø3
1Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
Journal of Pain Research
|July 31, 2014
Summary
Chronic pain patients struggle with decision-making, lacking anticipatory skin conductance responses (SCR) that guide choices in healthy individuals. This impaired decision-making in pain patients correlates with brain structure, unlike in controls.
Area of Science:
- Neuroscience
- Psychology
- Medical Imaging
Background:
- Chronic pain is linked to cognitive impairments, particularly in decision-making.
- Healthy individuals utilize anticipatory skin conductance responses (SCR) to guide decisions in tasks like the Iowa Gambling Task (IGT).
- Altered brain structure in decision-making regions is observed in chronic pain patients.
Purpose of the Study:
- To investigate if impaired decision-making in chronic pain patients is associated with a lack of anticipatory SCR.
- To explore the relationship between Iowa Gambling Task (IGT) performance and brain structure volumes in chronic pain patients.
Main Methods:
- Computerized Iowa Gambling Task (IGT) with concurrent recording of skin conductance response (SCR), heart rate, and blood pressure.
- Neuropsychological testing and three-dimensional T1-weighted cerebral magnetic resonance imaging (MRI).
- Comparison of 18 chronic pain patients with 19 matched healthy controls.
Main Results:
- Chronic pain patients did not exhibit anticipatory SCRs before unfavorable choices, unlike controls.
- Patients showed significantly more switching between card decks in the late IGT phase, even after adjusting for depression.
- In patients, IGT performance positively correlated with total cortical grey matter volume; in controls, IGT correlated with anticipatory SCR.
Conclusions:
- Reduced anticipatory SCR may impair decision-making in chronic pain.
- Chronic pain patients might rely more on cortical resources for decision-making due to diminished autonomic responses.
- Brain structure, specifically grey matter volume, is associated with decision-making performance in chronic pain patients.
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