Choosing well: A narrative review on chronic pain and decision-making

Chronic pain is one of the most prevalent and costly health conditions in the United States. Previous work has demonstrated that chronic pain impacts cognition and behavior. However, the impact of chronic pain on daily decisions is less well-known. This narrative review identified and synthesized findings from a literature search that yielded 18 peer-reviewed, experimental, cross-sectional studies on the effects of chronic pain on different decision-making outcomes. According to the literature, the effects of chronic pain on decision-making are evidenced by 1) reduced decision performance, 2) increased risk-taking and delay discounting, 3) altered sensitivity to outcomes, and 4) reduced cognitive flexibility and learning. Chronic pain effects on decision-making also vary by individual factors such as sex/gender, age, and affective and social factors. Guided by these findings, current limitations and future directions in the field are discussed. PERSPECTIVE: This narrative review highlights current evidence and identifies critical knowledge gaps, emphasizing a need to better understand the relationship between chronic pain and decision-making. Findings can guide future theory and shape interventions aimed at improving decision-making in chronic pain.