Brain Fog in Veterans with Pain Symptoms

Abstract

Veterans experience chronic pain at a rate twice higher than civilians. Brain fog (BF), a phenomenon of mental cloudiness associated with functional challenges in cognition, is one of the least studied symptoms of chronic pain. Pain interference, a construct of chronic pain, can limit participation with activities. Both BF and pain interference can disrupt quality of life (QoL) in Veterans by limiting health and meaningful participation. The relationship between BF and pain interference on QoL has not been investigated. Thus, the objective of this study is twofold: 1) understand the experience and 2) explore the impacts and the possible mitigation of pain interference of BF on the QoL, in Veterans with pain symptoms and BF. First, a qualitative descriptive method was employed using content and matrix analyses, to describe the impacts of brain fog on QoL in Veterans with BF and pain symptoms. The content analysis revealed the triggers, impacts, management strategies, and suggestions for healthcare professionals. The matrix analysis showed that women described difficulty managing BF with competing roles (e.g., motherly duties). Next, we conducted a cross-sectional study Veterans, exploring whether the perceived level of pain interference in Veterans with BF and pain symptoms affected measures of QoL. Results indicated Veterans with BF and high pain interference showed more mental health symptoms (p=0.003), and less perceived level of confidence with abilities (0.036) and physical health (p=0.003), than Veterans with BF and low pain interference. Post-hoc tests revealed no significant differences across gender. Next, to explore how QoL constructs we related, we performed an exploratory correlational analysis, revealing significant correlations between perceived level of confidence with abilities and 1) mental health (r=-0.48), 2) physical health (r=-0.44), and 3) functional cognition (-0.44). This study contributes to the overall knowledge of BF, guiding recommendations for the development of an assessment and research priorities.