title: Patients with chronic pain lack somatic markers during decision-making.
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.
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Nicolas-Andreas
authors: NA
authors: Elvemo
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway.
authors: Kristian Bernhard
authors: KB
authors: Nilsen
authors: Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway ; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Nils Inge
authors: NI
authors: Landrø
authors: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Anesthesiology, St Olav University Hospital, Trondheim, Norway.
authors: Petter Christian
authors: PC
authors: Borchgrevink
authors: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Medical Imaging, St Olav University Hospital, Trondheim, Norway.
authors: Asta Kristine
authors: AK
authors: Håberg
keywords: Iowa gambling task; autonomic measures; cortex; magnetic resonance imaging; skin conductance response