Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: an online, cross-sectional, observational study

Caitlin A. Howlett, Tyman Stanford, Carolyn Berryman, Emma L. Karran, Valeria Bellan, Scott Coussens, Stephanie Miles, G. Lorimer Moseley

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Introduction: People with persistent pain experience problems modifying their cognition and behaviours when task or environmental demands change – abilities otherwise known as cognitive flexibility. However, limitations and inconsistent results of previous studies raise concerns over the quality of that evidence. We aimed to determine whether people with and without persistent pain differ on two assessments that are commonly used to assess cognitive flexibility. We also examined the relationship between the two assessments and explored whether people with and without persistent pain are distinguishable based on their scores on these assessments. Methods: Participant demographics and symptoms of anxiety and depression were assessed. Participants completed the Cognitive Flexibility Inventory (CFI) and the Wisconsin Card Sorting Test (WCST). Multiple linear regression on the two outcome variables: CFI (total score) and WCST (% perseverative responses) was applied using backward stepwise selection. Both outcomes were calculated as a standardised proportion of the outcome scale and log-odds transformed to meet the model assumptions. Correlation analysis and logistic regression were used to investigate our secondary and exploratory aims. Results: Data were available from 128 participants with persistent pain and 68 pain-free controls. After adjusting for covariates, no differences were found between people with and without persistent pain on either assessment of cognitive flexibility. No significant correlations were detected between the two assessments in either group. The probability of having persistent pain was also not associated with scores on either or both assessments. Conclusion: ‘Cognitive flexibility’ appears similar in people with and without persistent pain.

Original languageEnglish
JournalBritish Journal of Pain
Publication statusAccepted/In press - 2023
Externally publishedYes


  • Chronic pain
  • cognitive flexibility
  • executive function
  • neuropsychology
  • self-report

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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