Neurocognitive impairments in chronic pain: Transdiagnostic approach and clinical implications

Chronic pain (CP) affects over 30% of the global population, as leading cause of disability significantly impairs quality of life and daily functioning. Evidence suggest that 20% of people with CP experience neurocognitive impairment. Various CP conditions, including nociplastic, neuropathic, nociceptive (i.e., musculoskeletal, post-surgical pain, among others), demonstrate distinct yet overlapping neurocognitive impairment, underscoring the need for transdiagnostic approaches. Although the problem remains underestimated, the impact of this burden is likely to increase further with the aging population and increasing prevalence of CP. To better understand how a transdiagnostic approach may be helpful in the comprehension of the co-occurrence of neurocognitive impairments and CP, this systematic-narrative hybrid literature review aims to synthesize the state of the art regarding neurocognitive impairments associated with CP, emphasizing clinical implications. A systematic literature search was conducted in PubMed, SCOPUS and EMBASE using keywords related to CP and neurocognitive impairments including peer reviewed articles published from inception to May 2025. Emerging evidence highlights the bidirectional relationship between CP and neurocognitive impairments, particularly in domains such as attention, memory, language, executive function, and perceptual-motor function across diverse populations with CP. A transdiagnostic perspective is needed to bridge the gap between clinical implications and future research. This study highlights the clinical significance of incorporating neurocognitive evaluations and treatments into CP management, advocating a shift towards more personalized and multimodal healthcare approaches. Considering the limitations of this review, further high-quality research is needed to better understand the underlying mechanisms and associated clinical implications.