# chicken and egg revisited



## trbell (Nov 1, 2000)

Hart et al (2003) reviewed studies that examine cognitive functioning in patients with chronic pain with an emphasis on the role of emotional distress and the mechanisms of stress-related effects. They found an association between psychological distress and cognitive impairment in patients with chronic pain, especially pain-related negative emotions and variables that mediate suffering such as interference with activities and increased somatic vigilance. Further, they report on recent evidence that psychological distress is related to cognitive impairment independent of the effects of pain intensity. In examining possible underlying neurophysiologic substrates, they noted that the Anterior Cingulate Cortex (ACC) plays an important role in pain processing and affective-motivational experience, and mediates the impact of pain-related emotional distress on cognitive functioning through allocation of attentional resources. In addition, maladaptive physiologic stress responses and dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis can produce negative effects on hippocampal function and memory. They postulated that the underlying mechanism for cognitive impairment may be the vigilant anticipation of unpredictable pain symptoms, especially in individuals high in trait neuroticism, which presents a significant stressor that repeatedly activates both the HPA axis and ACC areas, thereby disrupting cognitive efficiency. ...not to mention the other concomitants of chronic pain, including depression, sleep disturbance, fatigue, short term and chronic medication use, etc., all of which have support indicating that they independently affect cognition...and the combination effects are unknown, but make for interesting speculation...----------------------------------------------------------------------------------------------------------------------- Cognitive Impairment in Patients With Chronic Pain: The Significance of Stress Robert P. Hart, PhD, James B. Wade, PhD, and Michael F. Martelli, PhDCurrent Pain and Headache Reports 2003, 7:116-226 This review article examines the role of emotional distress and other aspects of suffering in the cognitive impairment that often is apparent in patients with chronic pain. Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated. Available at http://www.villamartelli.com Direct Link: http://www.angelfire.com/va/MFMartelliPhD/Hart.pdf tom


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