Executive Function: Application in the Rehabilitation of Chronic Pain

Executive function (EF) is a control mechanism of human cognition that provides the capability to select actions in relation to internal goals organized by the prefrontal cortex (PFC). The PFC is essential for the temporal integration of sensory information in the sequencing of optimum motor behavior to achieve an internal goal. The temporal integration of sensory information also explains why the PFC has an additional role in the central modulation of pain. Pain modulation and motor function are altered in chronic pain, and this alteration can contribute to the reduced physical activity. EF is the driver of conscious control of thought and action that is critical to rehabilitation in chronic pain. However, EF is impaired in chronic pain. Rehabilitation practitioners typically use activity modification, exercise, and movement to enhance function in patients with chronic pain; exercise has beneficial effects on EF. However, impairments in EF can be barriers to adherence to exercise, activity, and lifestyle modifications required to optimize rehabilitation. Greater awareness of EF can enhance rehabilitation. This narrative review explores current theories of EF structure and function, how impairment of EF can be assessed in a clinical context, and its implications for rehabilitation in chronic pain.