Subjective and Objective Cognitive Functioning in Chronic Pain: Associations with Resting-State EEG

Chronic pain (CP) is a multidimensional condition that encompasses a range of symptoms beyond the experience of pain itself. In addition to affective and physical symptoms, cognitive dysfunction is an increasingly recognized feature of CP. People with CP frequently report difficulties with concentration and memory, reflecting subjective cognitive complaints, and group-level studies indicate modest but consistent reductions in performance on standardized cognitive tasks, reflecting objectively measured cognitive performance, particularly in working memory. Importantly, subjective cognitive complaints (assessed using patient-reported outcome measures) and objectively measured cognitive performance (e.g., working memory capacity) often diverge in CP. This dissociation suggests that these measures capture distinct aspects of cognitive functioning, raising questions about how they relate to other symptom domains and overall functioning in CP. While CP is increasingly conceptualized as a disorder of brain function, the neural correlates of cognitive functioning - particularly with respect to subjective versus objective cognition - have not yet been examined in CP. Identifying such correlates could offer novel treatment targets and inform patient stratification with respect to cognitive functioning. Electroencephalography (EEG) is a well-established, scalable method for assessing brain function and has revealed altered neural activity and connectivity in CP. EEG, therefore, provides a practicable approach for linking measures of brain function with subjective and objective cognition, with potential relevance for identifying neural markers of clinically meaningful cognitive symptoms. In this study, we aim first to characterize the relationship between subjective and objective cognitive functioning in CP and how they relate to other CP symptoms. Second, we aim to explore how subjective and objective cognitive functioning relate to brain function assessed by resting-state EEG measures of neural activity and connectivity.