Altered Decision-Making Across Acute and Chronic Pain States: A Bias Towards Context-Dependent Valuations

Abstract Chronic pain has been linked to changes in learning and decision-making, but the underlying cognitive mechanisms remain unclear. In this study, 239 participants with either chronic, acute, or no pain completed a reinforcement learning task designed to dissociate choices based on global expected value from those driven by context-specific reinforcement history. While learning performance was comparable across groups, individuals with chronic pain relied more on recent reinforcement history and less on integrated value representations during decision-making. Computational modeling confirmed that a mixture model best captured behavior across groups, with the chronic pain group assigning significantly less weight to global expected values. The acute pain group showed an intermediate pattern, suggesting a potential transitional phenotype. This shift in valuation strategy was associated with the duration of pain rather than its intensity, suggesting that prolonged exposure to pain may gradually alter decision-making processes. These findings indicate a shift in valuation strategy associated with chronic pain, which may contribute to the persistence of maladaptive behaviors and offer a cognitive marker for pain chronification.