The The Role of Executive Functioning in Understanding Chronic Pain Experiences in Adolescence: A Pilot Multi-Method Study executive functioning and chronic pain

Main Article Content

Line Caes Ewan Wallace Christina Duncan Bruce Dick


Background: Optimal executive functioning is pivotal to successful self-management of chronic pain (e.g., by being able to adapt self-management behaviours to changing situations), thereby contributing to improved health-related quality of life. However, preliminary evidence points to impaired executive functioning in people with chronic pain. Despite adolescence being identified as a sensitive period for the development of appropriate self-management and executive functioning skills, little is known about the associations between chronic pain and executive functioning performance in adolescents. The aim of the study was to pilot a multi-method approach to compare executive functioning, chronic pain, and quality of life between adolescents with and without chronic pain.

Methods: A sample of 22 adolescents with chronic pain (12-18 years, 82% female, mean chronic pain duration = 6.68 years) and 13 pain-free adolescents (age and sex matched) participated. All participants completed a battery of neuropsychological tasks to assess the three key executive functioning components (i.e., inhibition, working memory and cognitive flexibility) and provided self-report on their executive functioning, pain experiences and health-related quality of life.

Results: In addition to confirming the feasibility of the methods, data revealed that 23-62% of adolescents with chronic pain showed problematic performance, using normative scoring, in all three executive functioning components and showed significantly lower performance on all three executive functioning components compared to pain-free adolescents. Self-reported, but not neuropsychologically assessed, working memory and emotional control difficulties were associated with more pain-related interference and lower health-related quality of life.

Conclusion: These preliminary findings reveal the critical need to screen for and address any potential deficits in executive functioning in adolescents with chronic pain to optimise their self-management of pain and subsequent health-related quality of life. The findings also illustrate the feasibility of and need for future systematic, multi-method and prospective investigations in larger samples to further clarify the cyclical associations between chronic pain and executive functioning in adolescents.

Keywords: adolescent, chronic pain, executive function, emotion regulation, quality of life

Article Details

How to Cite
CAES, Line et al. The The Role of Executive Functioning in Understanding Chronic Pain Experiences in Adolescence: A Pilot Multi-Method Study. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 17 june 2024. doi:
Research Articles


1. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135-168. doi: 10.1146/annurev-psych-113011-143750
2. Pandey A, Hale D, Das, S., Goddings AL, Blakemore SJ, Viner RM. Effectiveness of universal self-regulation–based interventions in children and adolescents: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(6):566-575. doi: 10.1001/jamapediatrics.2018.0232.
3. Ludwig NN, Sil S, Khowaja MK, Cohen LL, Dampier C. Executive functioning mediates the relationship between pain coping and quality of life in youth with sickle cell disease. J Pediatr Psychol. 2018;43(10):1160-1169. doi: 10.1093/jpepsy/jsy057.
4. Miller MM, Rohan JM, Delamater A, et al. Changes in executive functioning and self-management in adolescents with type 1 diabetes: a growth curve analysis. J Pediatr Psychol. 2013:38(1), 18-29. doi: 10.1093/jpepsy/jss100
5. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223-228. doi: 10.1016/S2352-4642(18)30022-1
6. Blakemore SJ, Choudhury S. Development of the adolescent brain: implications for executive function and social cognition. J Child Psychol Psychiatry. 2006;47(3-4):296-312. doi: 10.1111/j.1469-7610.2006.01611.x.
7. Mifflin K, Chorney J, Dick B. Attention and working memory in female adolescents with chronic pain and pain-free female adolescents: a preliminary pilot study. Clin J Pain. 2016;32(7):609-616. doi: 10.1097/AJP.0000000000000239
8. Weiss KE, Harbeck-Weber C, Zaccariello MJ, Kimondo JN, Harrison TE, Bruce, BK. Executive functioning in pediatric chronic pain: do deficits exist?. Pain Med. 2017;19(1):60-67. doi: 10.1093/pm/pnx020
9. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-287. doi: 10.1016/j.ejpain.2005.06.009
10. King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011;152:2729–2738. doi: 10.1016/j.pain.2011.07.016
11. Gauntlett-Gilbert J, Eccleston, C. Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning. Pain. 2007;131: 132-141. doi: 10.1016/j.pain.2006.12.021
12. Berryman C, Stanton TR, Bowering KJ, Tabor A, McFarlane A, Moseley GL. Do people with chronic pain have impaired executive function? A meta-analytical review. Clin Psychol Rev. 2014;34(7):563-579. doi: 10.1016/j.cpr.2014.08.003
13. Caes L, Dick B, Duncan C, Allan J. The cyclical relation between chronic pain, executive functioning, emotional regulation, and self-management. J Pediatr Psychol. 2021;46(3):286-292. doi: 10.1093/jpepsy/jsaa114.
14. Shunk AW, Davis AS, Dean RS. The Delis-Kaplan Executive Function System: test review. Appl Neuropsychol. 2006;13:275-279.
15. Latzman RD, Markon KE. The factor structure and age-related factorial invariance of the Delis-Kaplan Executive Function System (D-KEFS). Assessment. 2010;17(2), 172-184. doi: 10.1177/1073191109356254
16. Delis, DC, Kramer JH, Kaplan E, Holdnack J. Reliability and validity of the Delis-Kaplan Executive Function System: an update. J Int Neuropsychol Soc. 2004;10:301-303. doi: 10.1017/S1355617704102191
17. Wechsler D. WISC-V Administration and Scoring manual. Pearson: London; 2016.
18. Wechsler D. WAIS-IV Administration and Scoring manual. Pearson: London ; 2010.
19. Gioia GA, Isquith PK, Guy SC, Kenworthy L. The Behavior Rating Inventory of Executive Functioning. Lutz, FL: Psychological Assessment Resources; 2000.
20. Irwin DE, Varni JW, Yeatts K, DeWalt DA. Cognitive interviewing methodology in the development of a pediatric item bank: a patient reported outcomes measurement information system (PROMIS) study. Health Qual Life Outcomes. 2009;7(1):3. doi: 10.1186/1477-7525-7-3
21. Varni JW, Seid M, Rode CA. The PedsQL™: measurement model for the pediatric quality of life inventory. Med care.1999;37(2):126-139. doi: 10.1097/00005650-199902000-00003
22. Steinberg L. Cognitive and affective development in adolescence. Trends Cogn Sci. 2005;9(2):69–74. doi: 10.1016/j.tics.2004.12.005
23. Connelly M, Bromberg MH, Anthony KK, Gil KM, Franks L, Schanberg LE. Emotion regulation predicts pain and functioning in children with juvenile idiopathic arthritis: an electronic diary study. J Pediatr Psychol. 2012;37(1):43–52. doi: 10.1093/jpepsy/jsr088
24. Baker KS, Georgiou-Karistianis N, Lampit A, Valenzuela M, Gibson SJ, Giummarra MJ. Computerised training improves cognitive performance in chronic pain: a participant-blinded randomised active-controlled trial with remote supervision. Pain. 2018;159(4):644–655. doi:10.1097/j.pain. 0000000000001150
25. Lehto JE, Juujärvi P, Kooistra L, Pulkkinen L. Dimensions of executive functioning: Evidence from children. Br J Dev Psychol. 2003;21(1):59-80. doi: 10.1348/026151003321164627
26. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41(1):49–100. doi: 10.1006/cogp.1999.0734