Clinical Scorecard: Impulsivity and Cognitive Biases Related to Pain in Veterans Undergoing Treatment for Chronic Non-Malignant Pain

At a Glance

Key Highlights

• Veterans with CNMP exhibit greater psychological distress and delay discounting compared to controls.
• No significant increase in motoric impulsivity or attentional capture by pain-related stimuli in CNMP group.
• Psychological distress correlates with motoric impulsivity under pain-related conditions.
• Pain catastrophizing and kinesiophobia are predictive of pain intensity and disability.
• Chronic opioid use is associated with significant medical and psychiatric risks.
• CNMP group did not show greater attentional capture by pain-related stimuli.

Guideline-Based Recommendations

Diagnosis

• Assess psychological factors such as mood symptoms and pain catastrophizing in CNMP patients.
• Assess attentional bias toward pain-related stimuli.

Management

• Encourage safer cognitive-behavioral strategies for pain management over opioid use.

Monitoring & Follow-up

• Monitor psychological distress, impulsivity, and attentional biases in patients with CNMP.

Risks

• Be aware of the risk of developing opioid use disorder in patients with significant mood symptoms.

Patient & Prescribing Data

Veterans with chronic non-malignant pain.

Patients with high pain-related fear and catastrophizing may be more likely to seek opioids.

Clinical Best Practices

• Integrate psychological assessments into pain management plans.
• Promote non-opioid pain management strategies.
• Address kinesiophobia and pain catastrophizing in treatment.
• Monitor attentional biases in treatment plans.

References

• Chronic Pain Economic Burden
• Psychosocial Risks of Opioid Use
• Biopsychosocial Model of Pain