Nociceptive stress interferes with neural processing of cognitive stimuli in Gulf War Veterans with chronic musculoskeletal pain

• Published in: Life sciences (1973) Vol. 279; p. 119653
• Main Authors: Lindheimer, Jacob B., Stegner, Aaron J., Van Riper, Stephanie M., Ninneman, Jacob V., Ellingson, Laura D., Cook, Dane B.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 15.08.2021; Elsevier BV
• Subjects: Carbon monoxide; Chronic pain; Cognition; Cognition & reasoning; Cognitive ability; Cognitive tasks; Functional magnetic resonance imaging; Gulf War; Hyperalgesia; Information processing; Magnetic resonance imaging; Military; Military personnel; Neuropsychology; Pain; Pain perception; Persian Gulf War; Reaction time; Reaction time task; Variance analysis; War; Magnetic resonance imaging; Neuropsychology; Hyperalgesia
• ISSN: 0024-3205; 1879-0631
• DOI: 10.1016/j.lfs.2021.119653

Disrupted cognition and chronic musculoskeletal pain (CMP) are prevalent experiences among Gulf War Veterans (GWV). A negative association between CMP and cognition (i.e., chronic pain-related cognitive interference) has been observed in some chronic pain populations but has not been evaluated in GWV. Additional research suggests that disrupted cognition in GWV with CMP may be exacerbated by stressing the nociceptive system. Therefore, we compared cognitive performance and related neural activity between CMP and healthy control (CO) GWV in the absence and presence of experimental pain. During functional magnetic resonance imaging (fMRI), Veterans (CMP = 29; CO = 27) completed cognitive testing via congruent and incongruent conditions of a modified Stroop task (Stroop-only). A random subset (CMP = 13; CO = 13) also completed cognitive testing with experimental pain (Pain+Stroop). Yuen's modified t-test and robust mixed-model analysis of variance (ANOVA) models were used for analyzing cognitive performance data. Independent t-tests and repeated-measures ANOVA models were employed for fMRI data with thresholding for multiple-comparisons (p < 0.005) and cluster size (> 320 mm3). Functional MRI analysis revealed significant between-group differences for the incongruent but not congruent-Stroop run. Neither correct responses nor reaction time differed between groups in either Stroop condition (all p ≥ 0.21). Significant group (CMP, CO) by run (Stroop-only, Pain+Stroop) interactions revealed greater neural responses in CMP Veterans during Pain+Stroop runs. No significant interactions were observed for correct responses or reaction time (p ≥ 0.31). GWV with CMP require a greater amount of neural resources to sustain cognitive performance during nociceptive stress.