Association Between Chronic Pain and Jumping-to-Conclusions Behaviour

TL;DR

Chronic pain patients, including those with CRPS, tend to make premature decisions similar to those with mental disorders, and this behavior is linked to depression and anxiety.

Contribution

This study identifies a jumping-to-conclusions tendency in chronic pain patients, independent of CRPS subtype, and links it to psychological factors.

Findings

CRPS and non-CRPS patients showed significantly lower DTD compared to healthy controls, indicating a stronger tendency to jump to conclusions.

The JTC tendency was not influenced by CRPS phenotype but correlated with depressive and anxiety symptoms.

Pain intensity and disease duration did not correlate with JTC behavior.

Abstract

A tendency to jumping to conclusions (JTCs) was described in schizophrenia, in functional movement disorders and recently in a mixed group of chronic pain patients and has been discussed to indicate prefrontal dysfunction. This study investigated the tendency to premature decisions (JTC) in patients with complex regional pain syndrome (CRPS), a severe disorder affecting predominantly the distal limb, compared to healthy individuals and those with chronic limb pain from other causes, such as nerve injury or musculoskeletal abnormalities (non-CRPS).

In the classic ‘beads task', visual stimuli were used to assess evidence-based decision-making ability, followed by a variation with somatosensory stimuli. Thirty patients with CRPS were compared to 23 non-CRPS patients and 30 healthy individuals. Results were related to clinical data such as pain intensity, disease duration, CRPS phenotype based on predominant symptoms (central, peripheral and mixed) and standardized questionnaires evaluating depressive and anxiety symptoms. The main outcome was the number of draws to decision (DTD), i.e., how many beads participants requested before making a final judgement. Group differences were analysed using AN(C)OVA or Kruskal–Wallis tests with Bonferroni-corrected post hoc comparisons, unpaired t-tests and chi-squared tests as appropriate. Correlations between beads task performance and clinical parameters were examined using Pearson's or Spearman's analyses, while ANCOVA was applied to control for age, anxiety and depressive symptoms as covariates.

Both CRPS and non-CRPS patients showed a significantly stronger JTC tendency, deciding at a lower DTD (2.63 ± 1.19 and 2.65 ± 1.27, respectively) than healthy controls (5.13 ± 1.92, both p < 0.001), without differences between patient groups, and the effect was independent of the CRPS phenotypes. DTD correlated with depressive or anxiety symptoms and age but not with pain intensity or disease duration.

Dysfunctional processes leading to JTC seem to play a role in chronic pain patients and interact with depressive and anxiety symptoms. These interactions may impact treatment outcomes and warrant further investigation.

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