Masquerades of Brain Injury. Part I: Chronic pain and traumatic brain injury.
 

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Martelli, M.F., Zasler, N.D., Nicholson, K. and Hart, R.P. (2001).

The Journal of Controversial Medical Claims, 8, 2, 1-8.

Three reviews are presented which support the conclusion that pain and pain related symptomatology can and often do produce impaired performances on neuropsychological tests, especially measures assessing attentional capacity, processing speed, psychomotor speed, and executive functions. Consistent neurophysiologic findings support these conclusions derived from several lines of experimental and clinical research in humans and animals. Notably, chronic pain often does not cause cognitive impairments; when present, cognitive changes are likely reactive and reversible and symptoms associated with chronic pain, such as sleep disturbance, depression, medication use and premorbid coping vulnerabilities, likely play a predominant role in mediating the impact of chronic pain on cognitive functioning. Nonetheless, available findings indicate that chronic pain and its concomitants represent a source of performance variance and that caution is warranted in interpreting decrements in neuropsychological test scores as signs of neurologic sequelae of brain disease or injury in patients with chronic pain. Recommendations are offered which might help minimize the confounding effects of chronic pain on neuropsychological test performance.

 


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