The role of chronic pain and pain anxiety in delay discounting of pain and monetary losses

Pain may alter intertemporal decisions by modifying the value of pain-related outcomes. For example, a person with chronic back pain may be faced with two choices: undergo surgery that could provide long-term relief but would involve additional short-term pain and discomfort during recovery; or continue living with the chronic pain and avoid the surgery, thus leading to overall deteriorated health. Such choices are well captured by delay discounting, which is defined as the decline in the subjective value of an outcome as the delay of its receipt increases. We investigated general pain anxiety and delay discounting of monetary losses and pain in 255 individuals with and without chronic pain. We found that people with chronic pain tend to discount the value of pain outcomes more than those without chronic pain, suggesting that chronic pain may contribute to impulsivity in decision-making related to pain. Moreover, the effect of chronic pain on delay discounting was mediated through general pain anxiety. This result, however, should be taken with caution, because the effect sizes were small, and the path model was underpowered. In conclusion, people with chronic pain might be more likely to prioritize avoiding immediate discomfort and may undervalue the potential long-term benefits of actions that could alleviate their pain in the future.