A Topical Review on Executive Functioning in Chronic Non-malignant Pain: Do Different Neurocognitive Dysfunctions in Chronic Non-malignant Pain Reflect a Common Underlying Process?

Clinical observations reveal that cognitive impairments are frequently reported in chronic\nnon-malignant pain patients, and impairments in memory, attentional and executive functions have been found by performance-based neuropsychological tests. To days date, no systematic review has been conducted on cognitive impairment in this patient group. There is a need for clarification and systematization of the studies in this field. The aim of this study was to conduct a topical review on executive impairments in chronic pain, and systematize findings based on theoretical frameworks on executive functions and models of pain and attention. A database search identified 30 studies where evidence point towards deficits in executive function in chronic non-malignant pain. It is here concluded, based on the existing evidence, that the impairments might reflect an underlying deficit in executive control. This is supported by both clinical and experimental studies. In addition, executive control deficits are closely correlated with subjective reports of cognitive difficulties. This has implications for treatment of these symptoms. There may be possibilities to target this specific deficit by high-demanding working memory training programs. Future research should use methods from cognitive psychology to test out theory-driven hypotheses about the possibility of an underlying executive control deficit in chronic pain.