Cognitive Performance Is Related to Central
Sensitization and Health-related Quality of Life
in Patients with Chronic Whiplash-Associated
Disorders and Fibromyalgia
Authors: Meeus Mira 
Published: February 2021

Background: A growing body of research has demonstrated that impaired central pain modulation
or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic
whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing
evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients
often report problems with health-related quality of life (QoL). Yet, there is limited research concerning
the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients.
Objectives: (1) Examining the presence of cognitive impairment, CS, and limitations on healthrelated QoL in patients with chronic WAD and FM compared to healthy controls. (2) Examining
interrelations between performance-based cognitive functioning, CS, and self-reported healthrelated QoL in these 3 study groups.
Study Design: A case-control study was conducted.
Setting: The present study took place at the University Hospital Brussels, the University of Brussels,
and the University of Antwerp.
Methods: Fifty-nine patients (16 chronic WAD patients, 21 FM patients, and 22 pain-free volunteers)
filled out the Short Form 36 item Health Survey (SF-36), a self-reported psychosocial questionnaire,
to assess health-related QoL. Next, they were subjected to various pain measurements (pressure
hyperalgesia, deep-tissue hyperalgesia, temporal summation [TS], and conditioned pain modulation
[CPM]). Finally, participants completed a battery of performance-based cognitive tests (Stroop task,
psychomotor vigilance task [PVT], and operation span task [OSPAN]).
Results: Significant cognitive impairment, bottom-up sensitization, and decreased health-related
QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (P
< 0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly
related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to self-reported
health-related QoL (P < 0.05). Decreased cognitive performance was related to deficient central
pain modulation in healthy controls. Further, significant correlations between decreased cognitive
performance and reduced health-related QoL were revealed among all study groups. Additionally,
FM patients showed correlations between cognitive impairment and increased health-related QoL.
Remarkably, impaired selective attention and working memory were related to less TS, whereas
impaired sustained attention was correlated with dysfunctional CPM in FM patients.
Limitations: Based on the current cross-sectional study no firm conclusions can be drawn on the
causality of the relations.
Conclusion: In conclusion, this paper has demonstrated significant cognitive deficits, signs of CS,
and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals.
Significant relations between cognitive performance and CS as well as health-related QoL were
demonstrated. These results provide preliminary evidence for the clinical importance of objectively
measured cognitive deficits in patients with chronic WAD and FM.
Key words: Chronic pain, fibromyalgia, whiplash, central sensitization, conditioned pain
modulation, temporal summation, cognition, quality of life