title: Severe pain confounds neuropsychological test performance.
abstract: There is little information on the effect of pain on neuropsychological test performance. We have undertaken this study to explore which tests are affected by pain, the magnitude of these changes, and other confounders of neuropsychological performance in a population of patients having spine surgery. Twenty-four elderly English speaking Caucasian patients (age > 60 years) were enrolled pre-operatively in this Institutional Review Board approved study. Pain scores using an 11-point Numeric Pain Intensity scale and performance on a neuropsychological battery (Controlled Oral Word Association, Rey Complex Figure, Trails A and B) were assessed at two times, before and one day after surgery. Scores were calculated using the standard algorithms and change scores were calculated by subtracting the baseline from follow-up scores. After surgery, performance on the Rey Complex Figure ( r = -0.577, p = 0.004) and Trails Part A (r = 0.527, p = 0.01) declined with increasing post-operative pain scores. Women reported higher pain scores post-operatively than men (p = 0.046), and performed worse than men for change in performance on Trails Part A (p = 0.027). These data suggest that pain can influence performance on certain cognitive tests, and that some gender differences in these effects may occur. Interpretation of performance measures should take into account possible effects of pain, although our understanding of pain effects and ability to predict them in individual people, currently are quite limited.
authors.affiliation: Department of Anesthesiology, Columbia University, New York, NY 10032-3784, USA. ejh3@columbia.edu
authors.forename: E J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.forename: C J
authors.initials: CJ
authors.lastname: Winfree
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: D J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: P A
authors.initials: PA
authors.lastname: McCormick
authors.forename: D O
authors.initials: DO
authors.lastname: Quest
authors.forename: J G
authors.initials: JG
authors.lastname: McMurtry
authors.forename: C J
authors.initials: CJ
authors.lastname: Riedel
authors.forename: R M
authors.initials: RM
authors.lastname: Lazar
authors.forename: Y
authors.initials: Y
authors.lastname: Stern
authors.forename: E S
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000494:pharmacology*; D003071:Cognition / Q000187:drug effects; D017586:Diskectomy / Q000009:adverse effects / Q000523:psychology; D005260:Female; D006801:Humans; D007297:Inpatients; D007796:Laminectomy / Q000009:adverse effects / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology*; D012737:Sex Factors; D018709:Statistics, Nonparametric
chemical_list: D000700:Analgesics