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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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Cognitive flexibility and persistent post-surgical pain: the FLEXCAPP prospective observational study.

Molly R Vila1, Marko S Todorovic1, Cynthia Tang1

  • 1Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA.

British Journal of Anaesthesia
|March 15, 2020
PubMed
Summary

Poor preoperative cognitive flexibility did not predict persistent post-surgical pain. However, worse performance on the Stroop test was linked to greater pain severity after surgery.

Keywords:
arthroplastychronic paincognitionmastectomypostoperative painthoracotomy

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Area of Science:

  • Neuroscience
  • Pain Research
  • Psychology

Background:

  • Executive function deficits are associated with chronic pain.
  • Cognitive flexibility, the ability to adapt thinking to environmental changes, is a key executive function.
  • Persistent post-surgical pain (PSP) is a significant clinical challenge.

Purpose of the Study:

  • To investigate the association between preoperative cognitive flexibility and the development of PSP.
  • To determine if cognitive flexibility predicts PSP incidence and severity.

Main Methods:

  • A prospective observational study involving 300 patients undergoing total knee arthroplasty or noncardiac chest surgery.
  • Preoperative assessment of cognitive flexibility using the Trail Making Test and the colour-word matching Stroop test.
  • Comparison of test performance between patients who developed PSP and those who did not, with 6-month follow-up.

Main Results:

  • No significant difference in preoperative cognitive flexibility (Trail Making Test or Stroop test) between patients with and without PSP.
  • Poorer baseline performance on the Stroop test was associated with higher pain severity at 6 months in both surgical cohorts.
  • This association remained significant even after controlling for other factors.

Conclusions:

  • Preoperative cognitive flexibility was not a predictor of PSP incidence.
  • Impaired performance on the Stroop test, a measure of cognitive flexibility, is associated with greater PSP severity.
  • Targeting cognitive flexibility may offer a novel approach for managing PSP.