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Patients with chronic pain lack somatic markers during decision-making

Authors Elvemo N, Nilsen KB, Landrø NI, Borchgrevink PC, Håberg A

Received 15 February 2014

Accepted for publication 19 March 2014

Published 15 July 2014 Volume 2014:7 Pages 425—437

DOI https://doi.org/10.2147/JPR.S62492

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5


Nicolas-Andreas Elvemo,1 Kristian Bernhard Nilsen,1,2 Nils Inge Landrø,3,4 Petter Christian Borchgrevink,4,5 Asta Kristine Håberg1,6

1Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway; 3Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway; 4Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; 5Department of Anesthesiology, St Olav University Hospital, Trondheim, Norway; 6Department of Medical Imaging, St Olav University Hospital, Trondheim, Norway

Abstract: Patients with chronic pain have impaired cognitive functions, including decision making, as shown with the Iowa gambling task (IGT). The main aim of this study was to elucidate whether patients' decision making is associated with a lack of the anticipatory skin conductance response (SCR). An increase in anticipatory SCR before making unfavorable choices is known to guide decisions in healthy controls during the IGT. Since several brain regions involved in decision making are reported to have altered morphology in patients with chronic pain, the second aim was to explore the associations between IGT performance and brain structure volumes. Eighteen patients with chronic pain of mixed etiology and 19 healthy controls matched in terms of age, sex, and education were investigated with a computerized IGT during the recording of SCR, heart rate, and blood pressure. The participants also underwent neuropsychological testing, and three-dimensional T1-weighted cerebral magnetic resonance images were obtained. Contrary to controls, patients did not generate anticipatory SCRs before making unfavorable choices, and they switched between decks of cards during the late phase of the IGT significantly more often, and this was still observed after adjusting for depression scores. None of the other autonomic measures differed during IGT performance in either group or between groups. In patients, IGT scores correlated positively with total cortical grey matter volume. In controls, there was no such association, but their IGT scores correlated with the anticipatory SCR. It may be speculated that the reduction in anticipatory SCRs makes the chronic pain patients rely more on cortical resources during decision making.

Keywords: Iowa gambling task, skin conductance response, autonomic measures, magnetic resonance imaging, cortex

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