The Role of Cognitive Content and Cognitive Processes in Chronic Pain: An Important Distinction?

OBJECTIVES:Pain-related cognitive content (what people think about pain) and cognitive processes (how people think about pain; what they do with their pain-related thoughts) and their interaction are hypothesized to play distinct roles in patient function. However, questions have been raised regarding whether it is possible or practical to assess cognitive content and cognitive process as distinct domains. The aim of this study was to determine the extent to which measures that seem to assess mostly pain-related cognitive content, cognitive processes, and content and process, are relatively independent from each other and contribute unique variance to the prediction of patient function. MATERIALS AND METHODS:Individuals with chronic low back pain (N=165) participating in an ongoing RCT were administered measures of cognitions, pain, and function (depressive symptoms and pain interference) pretreatment. RESULTS:Analyses provided support for the hypothesis that cognitive content and cognitive process, while related, can be assessed as distinct components. However, the measure assessing a cognitive process-mindfulness-evidenced relatively weak associations with function, especially compared with the stronger and more consistent findings for the measures of content (catastrophizing and self-efficacy). DISCUSSION:The results provide preliminary evidence for the possibility that mindfulness could have both benefits and costs. Research to evaluate this possibility is warranted.