Recommended protocol for pain management

Chronic pain affects more than just physical health—it significantly impacts cognitive functioning, often in ways that patients may not recognize without formal assessment. Despite this, cognitive impairment is not routinely evaluated in pain management settings.

Why Cognitive Testing Matters in Pain Management

Cognitive impairments—including difficulties with memory, attention, and processing speed—are common among individuals living with chronic pain. These deficits can interfere with treatment adherence, self-management, and overall quality of life. According to Baker et al. (2017), cognitive dysfunction in chronic pain can be addressed through both targeted cognitive remediation and interventions aimed at secondary factors such as mood, sleep, and medication effects.

Patients with persistent pain—especially older adults—are at increased risk for cognitive decline, yet they often remain unaware of these changes unless objective testing is performed (Bell et al., 2022). For every two years of pain interference, there's a 21% increased risk of cognitive impairment.

Recommended Creyos Assessment Tasks

For patients in pain management, the following Creyos cognitive tasks are recommended:

• Paired Associates (Episodic Memory)

• Spatial Span (Spatial Short-Term Memory)

• Token Search (Working Memory)

• Feature Match (Attention)

• Optional: Double Trouble (Response Inhibition)

These tasks target domains most commonly affected by chronic pain and opioid use, such as attention, working memory, and episodic memory. The Double Trouble task may be particularly helpful when response inhibition is a concern or when evaluating patients experiencing high levels of cognitive interference from pain.

➤ Refer to our Condition-Based Research Guide for more information on the appropriate task selection for pain-specific conditions.

Supplemental Questionnaires

To further support diagnosis, treatment planning, and documentation of medical necessity, it is recommended to include validated behavioral health and risk assessment tools:

• PHQ-9 (Patient Health Questionnaire – Depression)

• GAD-7 (Generalized Anxiety Disorder – Anxiety)

• ORT (Opioid Risk Tool – Risk of Opioid Misuse)

• PMQ (Pain Medication Questionnaire – Risk of Aberrant Medication Behavior)

• AUDIT (Alcohol Use Disorders Identification Test) – if alcohol use is a concern

• DAST (Drug Abuse Screening Test) – if substance misuse is suspected

These instruments provide a comprehensive overview of factors that may contribute to or exacerbate cognitive impairment, including mood, substance use, and risk of medication misuse. 

Additional Considerations

• Documentation: Ensure that assessments are clearly documented to support the patient’s diagnosis, ongoing management, and treatment planning. Proper documentation is essential to establish medical necessity for testing and to support reimbursement.

• Testing Frequency: While quarterly (every 90 days) assessments are often reasonable in medication management with cognitive and behavioral concerns, the exact frequency should be tailored to medical necessity and payer policy guidelines.

Supporting Research and Use Cases

Numerous studies link chronic pain to cognitive deficits (Berryman et al., 2013–2014; Zhang et al., 2021). Creyos tasks have been used in studies of opioid withdrawal, migraine treatment, and fibromyalgia to detect and monitor cognitive function changes. For example:

• Sant et al. (2024) used Creyos tasks to demonstrate improved cognition alongside anxiety reduction in opioid withdrawal.

• Madrid et al. (2024) and Amendolara et al. (2024) highlight Creyos' use in migraine clinics as part of standard assessment protocols.

• Meta-analyses and clinical reviews consistently underscore the importance of monitoring attention, processing speed, and memory in pain patients.

➤ For more insights and scientific publications in the application of Creyos in pain management, see our Scientific Publication Research Studies.

Additionally, if you are looking for more detailed reimbursement information, visit the Reimbursement & Coding Support section.