DECISION-MAKING, COGNITIVE FLEXIBILITY AND REWARD PROCESSING IN CHRONIC BACK PAIN: A BEHAVIORAL AND EEG STUDY

Chronic pain (CP) is characterized by sensory symptoms but also emotional and cognitive comorbidities, which substantially affect quality of life and treatment outcomes. In particular, alterations in executive functions and motivation may play a critical role in patients’ reduced treatment adherence.
This project investigates the effects of hedonic reward on emotional decision-making and cognitive flexibility in individuals with chronic back pain, compared to age-matched healthy controls. By examining whether hedonic incentives could enhance motivational engagement and mitigate executive dysfunctions, the study aims to identify strategies to improve treatment adherence.
Emotional decision-making is assessed using the Iowa Gambling Task (IGT), while cognitive flexibility is measured with the Wisconsin Card Sorting Test (WCST). Electroencephalographic (EEG) activity is recorded during task performance. For the IGT, event-related potentials, specifically the Feedback-Related Negativity ​and the P300, are analyzed. In the WCST, EEG analyses focus on spectral power and coherence within the alpha and theta frequency bands. Additional measures include electrodermal activity, standardized questionnaires evaluating pain, mood, motivation, and quality of life, and neuropsychological assessments.
Preliminary data suggest that, compared to healthy controls, CP participants demonstrate altered performance on decision-making and cognitive flexibility tasks, along with changes in EEG markers associated with feedback processing and executive control. Notably, performances in both tasks among CP participants seem to positively correlate with their subjective evaluation of treatment efficacy. These initial results support the hypothesis that executive dysfunctions may influence perceived treatment efficacy and encourage further investigation into the motivational effects of reward within this system.