ArticleJournal of pain research2026
Depressive Symptoms as a Potential Mediator in the Association Between Pain and Cognitive Function: A Cross-Sectional Study.
Article in Journal of pain research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the association between pain intensity and cognitive function, and to explore the influence of demographic, clinical, and mood factors on this relationship. Design: Cross-sectional study. Setting: A tertiary comprehensive teaching hospital. Subjects: 2661 inpatients admitted for pain management who completed cognitive function screening. Methods: Pain intensity was assessed using the Numeric Rating Scale (NRS). Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Anxiety and depressive symptoms were assessed using the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD), respectively. Univariable and multivariable analyses were performed to examine the association between pain intensity and cognitive function, and mediation analysis was conducted to explore potential mediating effects. Results: The median pain duration was 3.0 months (IQR 0.6-12.0), and the median admission NRS score was 6 (IQR 4-6). Among the 2661 patients, 1502 (56.4%) had a MoCA score below 26, indicating mild cognitive impairment. Multiple linear regression model showed that higher pain intensity was significantly associated with higher MoCA (β = 0.22, 95% CI [0.12, 0.33], p < 0.001) after controlling for age, sex, education, pain duration, anxiety, and depression. Mediation analysis showed that baseline pain significantly predicted higher depressive symptoms (β = 0.41, p < 0.001), and depressive symptoms were negatively associated with cognitive performance (β = -0.16, p < 0.001). Conclusion: This large-scale cross-sectional study demonstrated a complex association between pain intensity and cognitive performance. While pain was directly associated with cognitive scores, depressive symptoms exerted a significant negative indirect effect, indicating partially opposing pathways. These findings suggest that mood-related mechanisms play a critical role in the pain-cognition relationship, highlighting the importance of integrating mood assessment into pain management.
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