Differential Predictive Capabilities of Cognitive Performance on Psychological Pain Variables in Chronic Low Back Pain.

BACKGROUND

Chronic low back pain (CLBP) is frequently accompanied by both maladaptive pain-related behaviors and alterations in cognitive processing. Although these domains are often studied independently, their interdependence, particularly whether cognitive performance may contribute to variability in pain-related psychological constructs, remains insufficiently characterized.

METHODS

In this cross-sectional investigation, 60 adults with CLBP completed validated questionnaires assessing pain catastrophizing (PCS), fear of movement (TSK), and symptoms associated with central sensitization (CSI). Cognitive function was evaluated across multiple domains, including attentional interference (Stroop Color Word Test), cognitive flexibility (CTMT2), and processing speed (Coding). Correlation and hierarchical regression analyses were performed to examine relationships and predictive effects while accounting for demographic and clinical factors.

RESULTS

PCS demonstrated consistent associations with reduced performance across all cognitive domains. Fear of movement was selectively related to attentional interference and processing speed, whereas central sensitization showed limited direct correlations. In regression models, cognitive flexibility (set-shifting) and processing speed significantly contributed to the prediction of catastrophizing, while only set-shifting independently predicted central sensitization.

DISCUSSION: These findings indicate that specific aspects of executive function-particularly cognitive flexibility-may play a meaningful role in shaping maladaptive pain-related cognitions. Incorporating cognitive assessment into clinical evaluation may provide additional insight into individual differences in pain presentation and treatment responsiveness.