Associations between cognitive test scores and pain tolerance: The Tromsø study

Abstract Objectives Previous studies have suggested that experimental pain sensitivity is associated with cognitive function. The aim of this study is to assess this relationship in a large population-based sample. Methods We included 5,753 participants (aged 40–84 years) from the seventh wave of the population-based Tromsø Study who had been examined with cognitive tests and experimental pain assessments, and for whom information on covariates were available. Cox regression models were fitted using standardized scores on cognitive tests (12-word immediate recall test, digit symbol coding test, and Mini-Mental State Examination [MMS-E]) as the independent variable and cold pressor or cuff pressure pain tolerance as the dependent variables. Statistical adjustment was made for putative confounders, namely, age, sex, education, smoking, exercise, systolic blood pressure, body mass index, symptoms indicating anxiety or depression, analgesic use, and chronic pain. Results In multivariate analysis, cold pressor tolerance time was significantly associated with test scores on the 12-word immediate recall test (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90–0.97, p < 0.001), the digit symbol coding test (HR 0.94, 95% CI 0.89–0.98, p = 0.004), and the MMS-E (HR 0.93, 95% CI 0.90–0.96 p < 0.001). Tolerance to cuff pressure algometry was significantly associated with 12-word immediate recall (HR 0.94–0.97, p < 0.001) and Digit Symbol Coding test scores (HR 0.93, 95% CI 0.89–0.96, p < 0.001) while there was no significant association with Mini Mental State Examination test score (HR 0.98, 95% CI 0.95–1.00, p = 0.082). Conclusion Lower pain tolerance was associated with poorer performance on cognitive tests.