Cognitive modulation of pain: Interaction between attention, inhibitory control, and pain perception

Introduction: A reciprocal modulation between cognitive processing and pain experience has been hypothesized, suggesting overlapping regulatory interactions between the circuits involved that may represent a complementary route to traditional pain management. Objective: To determine whether a cognitive test involving attention and inhibitory control (Flanker Inhibitory Control and Attention Test, FICAT) can modify pain perception and cognitive performance in healthy subjects. Materials and Methods: 40 students from the Metropolitan University (UNIMET), aged 18-25 years, were subjected to three experimental conditions. First, participants underwent the Cold Pressor Test (CPT). Then, they performed the FICAT and finally performed the FICAT while simultaneously exposed to the CPT. Pain intensity was evaluated using the Visual Analog Scale (VAS), and tolerance was measured in seconds, reflecting the total exposure time to the painful stimulus. Results: Compared to the pain-free scenario, the simultaneous application of noxious stimulation and cognitive testing significantly improved the subjects’ tolerance to painful stimuli but did not reduce the intensity of pain perception. In addition, the combination of FICAT+CPT significantly improved executive performance, reflected in faster reaction times. Discussion: Our results suggest that exposure to a painful stimulus does not necessarily disrupt the level of attention and the ability to exert inhibitory control. Moreover, executive capacity appears to be enhanced by the acute painful situation. Our findings also indicate that a cognitive task increased tolerance among the participants. Conclusion: These results suggest that complementary non-pharmacological strategies may help to reduce the cognitive burden of pain and partially improve how pain is behaviorally tolerated.