# Mental Function And Quality Of Life With Chronic Pain

> **NIH VA I21** · VA VETERANS ADMINISTRATION HOSPITAL · 2021 · —

## Abstract

Background: Chronic pain is common in Veterans and astute rehabilitation plans are critical to avoid deleterious
outcomes for functional outcomes and other quality of life (QoL). Attaining optimal functional outcomes after pain
rehabilitation is challenging, however, in cases when a significant portion of disability stems from “nonorganic”
psychological factors. Disability from primarily psychologically-driven factors would make a Veteran a poor
candidate for invasive medical procedures (which would have minimal benefit and potential harms). Nonorganic
pain has been traditionally probed using clinician-rated “Waddell signs.” However, these signs are inconsistently
probed, with questionable inter-rater reliability and can be challenging in the VHA wherein symptom endorsement
can be financially reinforced. Therefore, there is a critical need for a time-sensitive, hard-to-feign objective marker
of psychologically-driven disability for treatment planning. This project is a proof-of-concept study to determine
whether subconscious bias toward pain, such as attentional capture by pain-related stimuli, correlates with mood
symptomatology and clinician impressions of psychologically-driven disability at intake, with an exploratory aim
of relating bias metrics to pain treatment outcomes. Approach: Over a 15-month period, 50 Veterans slated for
assessment at a VA medical center (VAMC) pain clinic and 30 “control” Veterans slated for a non-pain-related
appointment (e.g. Primary Care) with minimal pain histories will identified from electronic medical records (EMR)
and approached prior to their intake appointment and invited to complete a ~90-minute assessment battery on
a portable touchscreen-tablet-PC, either in their home or at the VAMC. This battery will be composed of
interview-based instruments of pain symptomatology and disability (e.g. occupational function), affective
symptomatology and QoL, as well as performance of neurocognitive tasks of subconscious bias toward pain-
related concepts/words and pain-related images. Comparator tasks of impulsivity and frustration tolerance will
also be included. This assessment will conclude with the patient making ratings of the burden or aversiveness
of the assessments themselves. Six months following this assessment, participants will repeat by telephone
interview the pain symptom, pain disability and QoL assessment items probed at baseline. In addition to the core
goal of probing the feasibility of computerized bias assessment in Veterans with chronic pain, analyses will test
for: 1) differences in subconscious pain bias between pain and non-pain patients, and 2) correlations between
subconscious bias and mood/pain/disability/QoL symptom scores at baseline, to assess the core validity of
probing subconscious bias measures in pain patients. As value-added supplemental analyses, we will: 1) relate
assessment items (both bias tasks and interview instrument scores) to Waddell ratings of intake clinicians noted
in E...

## Key facts

- **NIH application ID:** 10254010
- **Project number:** 1I21RX003723-01
- **Recipient organization:** VA VETERANS ADMINISTRATION HOSPITAL
- **Principal Investigator:** James M Bjork
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10254010

## Citation

> US National Institutes of Health, RePORTER application 10254010, Mental Function And Quality Of Life With Chronic Pain (1I21RX003723-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10254010. Licensed CC0.

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