An Experimental Investigation and Conditional Process Analysis of the Role of Catastrophizing in the Pain — Working Memory Nexus

Abstract

There is a well-documented bidirectional relationship between pain and cognitive dysfunction, especially working memory. Despite this extensive body of research, the pain–working memory relationship is poorly understood. Pain catastrophizing – exaggerated negative cognitive and emotional responses towards pain – may contribute to working memory deficits by occupying finite, shared cognitive resources, but this has yet to be investigated. The present study sought to clarify the role of pain catastrophizing (assessed as both a trait-level disposition and state-level process) in working memory dysfunction. Healthy undergraduate participants were randomized to an ischemic pain or control task, during which they completed verbal and non-verbal working memory tests. They also completed measures of state- and trait-level pain catastrophizing. Mediation analyses indicated that state-level pain catastrophizing mediated the relationships of pain group to both verbal and non-verbal working memory, such that participants in the pain group (vs. the control group) catastrophized more about their pain, which then resulted in worse verbal and non-verbal working memory performance. In moderated mediation analyses, trait-level pain catastrophizing moderated this mediation effect for both verbal and non-verbal working memory. Those participants in the pain group who reported greater tendency to catastrophize about pain in general exhibited greater catastrophizing in-the-moment during the pain task, thereby leading to worse verbal and non-verbal working memory performance. These results provide evidence for pain catastrophizing as a putative mechanism and moderating factor of working memory dysfunction in pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep), and develop interventions to ameliorate cognitive dysfunction by targeting pain catastrophizing.