Chronic Low Back Pain Linked to Impaired Cognitive Performance Across Multiple Domains

Adults with chronic low back pain (LBP) demonstrate significantly worse performance in executive function, memory, motor skills, and processing speed compared with pain-free individuals, according to a systematic review and meta-analysis published in The Journal of Pain.

Low back pain is the leading cause of global disability and contributes substantially to health care costs, particularly when it becomes chronic. While chronic LBP is traditionally managed with a focus on physical symptoms, growing evidence suggests it may also impair cognitive function. However, prior studies have varied widely in quality and methodology, limiting confidence in their findings.

To address this knowledge gap, researchers conducted a systematic review and random-effects meta-analysis of 26 studies comprising 5572 adults — 2187 with chronic LBP and 3385 pain-free individuals. Cognitive performance was evaluated across 8 domains using validated measures.  

Among patients with chronic LBP and pain-free individuals, the mean age range was 27 to 80 years. The mean duration of LBP was 34 to 317 months and mean LBP intensity ranged from 19 to 80 points on a 100-point scale.

Compared with control patients, adults with chronic LBP showed significant deficits in executive function (Hedges’ g, 0.50; 95% CI, 0.27-0.74; P <.001), memory (Hedges’ g, -0.65; 95% CI, -0.90 to -0.41; P <.001), motor skills (Hedges’ g, 0.44; 95% CI, 0.25-0.64; P <.001), and processing speed (Hedges’ g, 0.27; 95% CI, 0.03-0.51; P =.027). A smaller, though statistically significant, impairment in global cognition was also observed (Hedges’ g, -0.23; 95% CI, -0.43 to -0.04; P =.018). No significant differences emerged in attention, language, or perception.

Although these results remained consistent across sensitivity analyses, the overall certainty of evidence was rated as very low for most cognitive domains due to issues of imprecision and inconsistency. Meta-regression analyses revealed that age significantly moderated the association between chronic LBP and global cognition (β=0.02; P <.001; R²=90%), but not executive function or memory.

Limitations of the study include reliance on cross-sectional designs, which limit causal interpretations, and a lack of sufficient data to assess reporting biases or conduct subgroup analyses across all cognitive domains. Further, the low to very low certainty of evidence suggests that future high-quality studies may influence these estimates.

The researchers concluded, “While there is a lack of evidence regarding causal mechanisms, assessing cognitive function among adults with [chronic] LBP appears warranted.”

This article originally appeared on Clinical Pain Advisor