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Chiari 1000 Registry Project: assessment of surgical outcome on self-focused attention, pain, and delayed recall

  • P. A. Allen (a1), D. Delahanty (a2), K. P. Kaut (a1), X. Li (a1), M. Garcia (a2), J. R. Houston (a1), D. M. Tokar (a1), F. Loth (a3), J. Maleki (a4), S. Vorster (a5) and M. G. Luciano (a6)...



Prior research has typically found a negative relationship between chronic pain and memory, and we examined whether cognitive control processes (e.g. reflection and rumination) moderated this relationship in individuals with Chiari malformation Type I (CM). CM is a neurological condition in which the cerebellar tonsils descend into the medullary and upper cervical spine regions potentially resulting in severe headaches and neck pain.


CM patients who had (n = 341) and had not (n = 297) undergone decompression surgery completed the McGill Pain Questionnaire-Short Form-Revised (SF-MPQ-2), the Rey Auditory Verbal Learning Test (RAVLT), and the Rumination-Reflection Questionnaire (RRQ). Immediate recall scores were compared to those of 102 healthy controls, and delayed recall performance was compared across other variables within the CM group.


CM patients performed more poorly on immediate recall than did controls. Within CM patients, we observed main effects for reflection and age, and a pain x reflection x surgical status (surgery v. no surgery) interaction in which non-decompressed individuals with low levels of pain and high levels of reflection showed superior delayed recall relative to non-decompressed individuals with higher pain and all decompressed individuals.


CM patients show an immediate recall deficit relative to controls, regardless of surgical status. High levels of reflection were associated with better delayed recall performance in non-decompressed CM patients with lower pain levels. High levels of chronic pain may overwhelm increased focused attention abilities, but higher levels of reflection partially overcome the distracting effects of pain and this may represent a type of resilience.


Corresponding author

Author for correspondence: P. A. Allen, E-mail:


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Allen, PA, Houston, JR, Pollock, JW, Buzzelli, C, Li, X, Harrington, AC, Martin, BA, Loth, F, Lien, M-C, Maleki, J and Luciano, MG (2014) Task-specific and general cognitive effects in Chiari malformation Type I. PLoS ONE 9, e94844.
Allen, PA, Kaut, KP, Baena, E, Lien, M-C and Ruthruff, E (2011) Individual differences in positive affect moderate age-related declines in episodic long-term memory. Journal of Cognitive Psychology 23, 768779.
Allen, PA, Kaut, KP, Lord, RG, Hall, RJ, Bowie, T and Grabbe, J (2005) An emotional mediation theory of differential age effects in episodic and semantic memory. Experimental Aging Research 31, 355391.
Anderson, DW, Ellenberg, JH, Leventhal, CM, Rheingold, SC and Rodriguez, M and Silberberg, DH (1992) Revised estimate of the prevalence of multiple sclerosis in the United States. Annals of Neurology 31, 333336.
Baena, E, Allen, PA, Kaut, KP and Hall, RJ (2010) On age differences in prefrontal function: the importance of emotional/cognitive integration. Neuropsychologia 48, 319333.
Beaty, RE, Kaufman, SB, Benedek, M, Jung, RE, Kenett, YN, Jauk, E, Neubauer, AC and Silvia, PJ (2016) Personality and complex brain networks: the role of openness to experience in default network efficiency. Human Brain Mapping 37, 773779.
Bechara, A, Damasio, H, Damasio, AR and Lee, GP (1999) Different contributions of the human amygdala and ventromedial prefrontal cortex to decision making. The Journal of Neuroscience 19, 54735481.
Berryman, C, Stanton, TR, Bowering, KJ, Tabor, A, McFarlane, A and Moseley, GL (2013) Evidence for working memory deficits in chronic pain: a systematic review and meta analysis. PAIN 154, 11811196.
Bosma, FK and Kessels, RP (2002) Cognitive impairments, psychological dysfunction, and coping styles in patients with chronic whiplash syndrome. Neuropsychiatry, Neuropsychology & Behavioral Neurology 15, 5665.
Cardoso-Cruz, H, Sousa, M, Vieira, JB, Lima, D and Galhardo, V (2013) Prefrontal cortex and mediodorsal thalamus reduced connectivity is associated with spatial working memory impairment in rats with inflammatory pain. PAIN 154, 23972406.
Damasio, AR (1994) Descartes’ Error: Emotion, Reason, and the Human Brain. New York, NY: Grosset/Putnam.
DaSilveira, A, DeSouza, ML and Gomes, WB (2015) Self-consciousness concept and assessment in self-report measures. Frontiers in Psychology 6, 930.
Doberstein, CA, Torabi, R and Klinge, PM (2017) Current concepts in the pathogenesis, diagnosis, and management of Type I Chiari malformations. Rhode Island Medical Journal: Recent Advances in Neurosurgery 100, 4749.
Dworkin, RH, Turk, DC, Revicki, DA, Harding, G, Coyne, KS, Peirce-Sandner, S, Bhagwat, D, Everton, D, Burke, LE, Cowan, P, Farrar, JT, Hertz, S, Maxi, MB, Rappaport, BA and Melzack, R (2009) Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). PAIN 144, 3542.
Eccleston, C and Crombez, G (1999) Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin 125, 356366.
Exner, C, Martin, V and Rief, W (2009) Self-focused ruminations and memory deficits in obsessive-compulsive disorder. Cognitive Therapy Research 33, 163174.
Fairbanks, CT, Couper, C, Davies, JB and O'Brien, JP (1980) The Oswestry low backpain disability questionnaire. Physiotherapy 66, 271273.
Fischbein, R, Saling, JR, Marty, P, Kropp, P, Meeker, J, Amerine, J and Chyatte, MR (2015) Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national Conquer Chiari Patient Registry database. Neurological Science 36, 16171624.
Houston, JR, Eppelheimer, MS, Pahlavian, SH, Biswas, D, Urbizu, A, Martin, BA, Bapuraj, JR, Luciano, MG, Allen, PA and Loth, F (in press). A morphometric assessment of type 1 Chiari malformation above the McRae line: a retrospective case-control study in 302 adult female subjects. Journal of Neuroradiology.
Kumar, M, Rathore, RKS, Srivastava, A, Yadav, SK, Behari, S and Gupta, RK (2011) Correlation of diffusion tensor imaging metrics with neurocognitive function. World Neurosurgery 76, 189194.
Lacy, M, Ellefson, SE, DiDios-Stern, S and Frim, DM (2016) Parent-reported executive dysfunction in children and adolescents with Chiari malformation Type 1. Pediatric Neurosurgery 51, 236243.
Lezak, MD, Howieson, DB and Loring, DW (2004) Neuropsychological Assessment, 4th Edn. Oxford University Press: New York.
Luciano, M, Martin, B, Allen, P and Loth, F (2014) The squeeze of Chiari malformation: clinicians and scientists collaborate to understand it cause and effects. Pediatric Neuroscience Pathways.
Magal, A (2013) A hypothetical universal model of cerebellar function: reconsideration of the current dogma. Cerebellum 12, 758772.
McCracken, LM (1997) ‘Attention’ to pain in persons with chronic pain: a behavioral approach. Behavioral Therapy 28, 271284.
Melzack, R and Wall, RD (1982) The Challenge of Pain. New York: Penguin.
Moriarty, O, McGuire, BE and Finn, DP (2003) The effect of pain on cognitive function: a review of clinical and preclinical research. Progress in Neurobiology 93, 385404.
Nouwen, A, Cloutier, C, Kappas, A, Warbrick, T and Sheffield, D (2006) Effects of focusing and distraction on cold pressor-induced pain in chronic back pain patients and control subjects. Journal of Pain 7, 6271.
Schmahmann, JD (2010) The role of the cerebellum in cognition and emotion: personal reflections since 1982 on the dysmetria of thought hypothesis, and its historical evolution from theory to therapy. Neuropsychology Review 20, 236260.
Schmahmann, JD (2004) Disorders of the cerebellum. Ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome. Journal of Neuropsychiatry and Clinical Neurosciences 16, 367378.
Schmahmann, JD and Sherman, JC (1998) The cerebellar cognitive affective syndrome. Brain, 121: 561579.
Schmidt, M (1996) Rey Auditory and Verbal Learning Test: A Handbook. Los Angeles. CA: Western Psychological Services.
Shaffer, N, Martin, B and Loth, F (2011) Cerebrospinal fluid hydrodynamics in type I Chiari malformation. Neurological Research 33, 247260.
Speer, MC, Enterline, DS, Mehltretter, L, Hammock, P, Joseph, J, Dickerson, M, Ellenbogen, RG, Milhorat, TH, Hauser, MA and George, TM (2003) Chiari Type I malformation with or without syringomyelia: prevalence and genetics. Journal of Genetic Counseling 12, 297311.
Trapnell, PD and Campbell, JD (1999) Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. Journal of Personality and Social Psychology 76, 284304.
Veehof, MM, Trompetter, HR, Bohlmeijer, ET and Schreurs, KMG (2016) Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behavior Therapy 45, 531.
Wadlinger, HA and Isaacowitz, DM (2011) Fixing our focus: training attention to regulate emotion. Personality and Social Psychology Review 15, 75102.
Walsh, BT, Seidman, SN, Sysko, R and Gould, M (2002) Placebo response in studies of major depression: variable, substantial, and growing. JAMA 287, 18401847.



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