Clinical pain, abstraction, and self-control: being in pain makes it harder to see the forest for the trees and is associated with lower self-control

Objectives: Although abstract thinking is a fundamental dimension of human cognition, it has received scant attention in research on pain and cognition. We hypothesized that physical pain impairs abstraction, because when people experience pain at high intensity levels, attention becomes concretely focused on the self in the here and now, where little else matters than finding relief for the pain they are currently experiencing. We also examined the relationship between pain and self-control, predicting that pain would debilitate self-control. Patients and methods: Abstraction and self-reported self-control were assessed in 109 patients with musculoskeletal pain. The influence of specific pain qualities, such as pain intensity, pain interference with daily activities, pain duration, and pain persistence, was examined. Furthermore, we assessed other factors (e.g., anxiety, depression, and fatigue) that could be assumed to play a role in the pain experience and in cognitive performance. Results: Higher pain intensity and persistence were associated with less abstract thinking. Furthermore, self-control decreased with greater pain intensity, persistence, and self-reported pain interference with daily activities. Self-reported depressive symptoms mediated the overall relationship between pain and self-control. Conclusion: Abstraction is compromised in patients reporting higher pain intensity and persistence. Different dimensions of pain also predict lower self-control although depression seems to account for the relationship between overall pain and self-control. The current study is the first to report an association between clinical musculoskeletal pain and abstraction. The results suggest that pain patients may suffer from a broader range of cognitive disadvantages than previously believed.