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Cognitive performance is of clinical importance, but is unrelated to pain with CFS

Discussion in 'Latest ME/CFS Research' started by Ecoclimber, Jun 6, 2013.

  1. Ecoclimber

    Ecoclimber Senior Member

    Clin Rheumatol. 2013 Jun 5. [Epub ahead of print]
    Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome.
    Ickmans K, Meeus M, Kos D, Clarys P, Meersdom G, Lambrecht L, Pattyn N, Nijs J.

    Pain in Motion Research Group (PIM), Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building L, Pleinlaan 2, 1050, Brussels, Belgium.


    In various chronic pain populations, decreased cognitive performance is known to be related to pain severity. Yet, this relationship has not been investigated in patients with chronic fatigue syndrome (CFS). This study investigated the relationship between cognitive performance and (1) pain severity, (2) level of fatigue, and (3) self-reported symptoms and health status in women with CFS. Examining the latter relationships is important for clinical practice, since people with CFS are often suspected to exaggerate their symptoms. A sample of 29 female CFS patients and 17 healthy controls aged 18 to 45 years filled out three questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Checklist Individual Strength (CIS), and CFS Symptom List) and performed three performance-based cognitive tests (psychomotor vigilance task, Stroop task, and operation span task), respectively. In both groups, pain severity was not associated with cognitive performance. In CFS patients, the level of fatigue measured with the CFS Symptom List, but not with the CIS, was significantly correlated with sustained attention. Self-reported mental health was negatively correlated with all investigated cognitive domains in the CFS group. These results provide evidence for the clinical importance of objectively measured cognitive problems in female CFS patients. Furthermore, a state-like measure (CFS Symptom List) appears to be superior over a trait-like measure (CIS) in representing cognitive fatigue in people with CFS. Finally, the lack of a significant relationship between cognitive performance and self-reported pain severity suggests that pain in CFS might be unique.

    Valentijn and taniaaust1 like this.
  2. vamah

    vamah Senior Member

    Washington , DC area
    This is interesting, but I'm thinking the sample size may be too small.
    Bob likes this.
  3. lnester7

    lnester7 Seven

    Well in my situation: Brain fog comes with overdoing (pain not present yet), If I keep pushing then comes the Crash then the pain starts, it could be hours to 3 days afterwards.
    Valentijn, taniaaust1 and Bob like this.
  4. AbbyDear


    I may not understand exactly what the study was about or what was determined, but some thougths came to mind:
    1. i have quite often wondered if the cognitive impairment was due to the pain "overloading" the brain, electrically, stimulatory,... or if it was related to increased immune complexes, e.g. cytokines, wbc, nkc, etc., or both.
    2. i, generally, under-report the severity of the symtpoms, afraid of appearing too sick or looking for attention, and generally regret later i did not better reflect the situation.
    3. i am not so much a fan of the pych tests, for measuring cognitive performance, for a number of reasons. i do not believe it is that accurate of an assessment, maybe for late-stage Alzheimer it is ok (which would be too-late indicator btw), but i question it for real-life professional performance. For example, there was a test that read a story several times (like more than 5) to test recall - this is not really practical in a meeting situation, generally time is short/rushed. i believe we are better at determining how difficult it is to think, remember, comprehend, simply perform a task, etc. , unfortunately, they have to trust us for this information, but maybe good questioning can help to quantifiy/qualify it better.
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  5. Bob


    England (south coast)
    It's a vaguely interesting study, but I don't think it tells us much.

    I think we probably all have subtly difference mixes of pain vs fatigue vs cognitive issues.

    All my symptoms tend to increase and decrease together, but I've (unusually?) never experienced pain (as opposed to exhaustion and severe malaise) at rest.

  6. smurf


    Same here. In my case, a threshold has to be crossed before pain is imminent and acute. Otherwise, it is just there, as a chronic annoyance, partially controlled by Flexeryl and Gabapentin. With moderate exertion, severe cognitive problems emerge and precede the onset of acute pain. Once the acute pain starts, the cognitive difficulties increase significantly and can last for weeks. All other symptoms also increase exponentially and start to meld together and become collectively intolerable. Perhaps due to overload, as some of you suggest. So, my personal experience tells me that with the appropriate patient sample you probably would find an association between pain and cognitive status and possibly all other symptoms. Crossing the PEM threshold is key to what follows. I suspect these guys might be pain specialists dabbling in ME/CFS! Of course, I could be wrong.

    I am so glad to see that the work of Mella and Fluge is starting to open minds regarding ME/CFS.
    vamah likes this.
  7. roxie60

    roxie60 Senior Member

    Central Illinois, USA
    Are they friggin kidding???? :mad: Pain has no bearing on cognitive ability o_O Maybe when coupled with so many other symps ..... I ant even get my thought across on this study. Good grief. I could see a true statement being intelligence is not impacted by pain but being able to mentally process most certainly can be impacted by pain levels along with a myriad of other symps. Who is paying for these studies, did they get the results they paid for ???? :rolleyes:
    AbbyDear, Bob and Shell like this.
  8. taniaaust1

    taniaaust1 Senior Member

    Sth Australia
    My cognitive performance decreases badly with my POTS or with exhaustion rather then due to pain, it can be very very terrible with no pain there at all (at one point I was forgetting what everyday objects are and what they are used for.. I didnt have any pain at the time). So I think most of our cognitive issues will be there pain or not and that our main cognitive issues are being caused by something other then pain, so its great to have researchers who arent going to just put that symptom down to "pain".

    Thou I also have no doubt if this study was redone with those who have severe pain and ME (I wonder how many of that ME/CFS group in this study had bad pain at the time while being tested?), that they would find that pain is "adding too" the cognitive problems that group already has.
    ahimsa, Valentijn and Bob like this.
  9. biophile

    biophile Places I'd rather be.

    To me this result suggests that cognitive dysfunction is central to the illness, not just a consequence of distraction.
    ahimsa, Bob, GracieJ and 2 others like this.
  10. GracieJ

    GracieJ Senior Member

    While applying for disability, I met with a psychologist for an assessment. I explained the cognitive shortage I experience constantly, and the psychologist assessing me called it "apprehension" o_O:p related to the task at hand in a work setting. I am not an eye-roller, but that one brought on the eye-rolling. Please! If I had to repeat the same cognitive tasks in a job day in, day out, with goals and results, I would very much be in trouble. Pain does not have to be a factor, though for sure what cognition remains is in worse trouble if I am experiencing pain or exhaustion.

    (No, I did not get disability.)
  11. Shell

    Shell Senior Member

    Pain can finish me. When it's that deep grinding pain or a migraine I can't process anything. That bone crushing PEM pain makes it difficult to speak coherently let alone complete tasks. I never go near a doc when I'm in that kind of pain - it's impossible.
    And it's time medics, researchers and whoever else out there drops this "House-ian" view that patients are lying, exaggerating or otherwise being dishonest.

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