title: Cognition and emotional decision-making in chronic low back pain: an ERPs study during Iowa gambling task.
abstract: Previous reports documented abnormalities in cognitive functions and decision-making (DM) in patients with chronic pain, but these changes are not consistent across studies. Reasons for these discordant findings might include the presence of confounders, variability in chronic pain conditions, and the use of different cognitive tests. The present study was aimed to add evidence in this field, by exploring the cognitive profile of a specific type of chronic pain, i.e., chronic low back pain (cLBP). Twenty four cLBP patients and 24 healthy controls underwent a neuropsychological battery and we focused on emotional DM abilities by means of Iowa gambling task (IGT). During IGT, behavioral responses and the electroencephalogram (EEG) were recorded in 12 patients and 12 controls. Event-related potentials (ERPs) were averaged oﬄine from EEG epochs locked to the feedback presentation (4000 ms duration, from 2000 ms before to 2000 ms after the feedback onset) separately for wins and losses and the feedback-related negativity (FRN) and P300 peak-to-peak amplitudes were calculated. Among cognitive measures, cLBP patients scored lower than controls in the modified card sorting test (MCST) and the score in this test was significantly influenced by pain duration and intensity. Behavioral IGT results documented worse performance and the absence of a learning process during the test in cLBP patients compared to controls, with no effect of pain characteristics. ERPs findings documented abnormal feedback processing in patients during IGT. cLBP patients showed poor performance in the MCST and the IGT. Abnormal feedback processing may be secondary to impingement of chronic pain in brain areas involved in DM or suggest the presence of a predisposing factor related to pain chronification. These abnormalities might contribute to the impairment in the work and family settings that often cLBP patients report.
authors.affiliation: Section of Neurology, Department of Neurological and Movement Sciences, University of Verona Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.affiliation: Section of Neurology, Department of Neurological and Movement Sciences, University of Verona Verona, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Maier
authors.affiliation: Department of Medicine, University of Padova Padova, Italy.
authors.forename: Sami
authors.initials: S
authors.lastname: Schiff
authors.affiliation: Section of Neurology, Pederzoli Hospital, Peschiera del Garda Verona, Italy.
authors.forename: Matteo F
authors.initials: MF
authors.lastname: Lauriola
authors.affiliation: Department of General Psychology, University of Padova Padova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Di Rosa
authors.affiliation: Section of Neurology, Pederzoli Hospital, Peschiera del Garda Verona, Italy.
authors.forename: Giampietro
authors.initials: G
authors.lastname: Zanette
authors.affiliation: Department of General Psychology, University of Padova Padova, Italy ; Human Inspired Technologies Research Center, University of Padova Padova, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mapelli
keywords: Iowa gambling task (IGT); chronic pain; decision-making; event-related potentials (ERPs); low back pain