{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:22:14Z","timestamp":1790202134333,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic spine pain is linked to self\u2010reported cognitive complaints. However, objective markers are lacking. The 90\u2010s Continuous Visual Attention Test (CVAT) quantifies key attention subdomains: reaction time (RT, alertness), RT variability (VRT, sustained attention), omission errors (focused attention) and commission errors (impulsivity).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to identify which specific attentional subdomains, measured by the CVAT, are impaired in adults with chronic spine pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective case\u2013control study included 84 adults with chronic lumbar\/cervical pain (\u2265\u20093\u2009months) and 118 healthy controls. A MANCOVA tested group differences on CVAT variables, controlling for age and sex, followed by Bonferroni\u2010corrected ANCOVAs. To isolate cognitive variability from general processing speed, the coefficient of variability (VRT\/RT) was also analysed. Logistic regression assessed the predictive power of CVAT indices for pain status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The MANCOVA showed a significant group effect (Pillai's Trace\u2009=\u20090.46,\n                      <jats:italic>F<\/jats:italic>\n                      (4,195)\u2009=\u200941.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients exhibited impairments in all measures\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 (\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.093\u20130.44). The VRT deficit persisted when using VRT\/RT. Logistic regression identified VRT as the strongest predictor of chronic spine pain (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      (1)\u2009=\u2009147.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), correctly classifying 86.6% of participants. This finding remained when using VRT\/RT (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      (1)\u2009=\u2009130.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 82.7% accuracy).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with chronic spine pain demonstrate attentional deficits, with sustained attention instability (VRT and VRT\/RT) as the most robust marker. The CVAT detects this impairment, offering a practical tool for clinical assessment to inform treatment and monitor cognitive function in pain management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III (prospective case\u2013control).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>A brief, 90\u2010s computerized attention test provides an objective, clinic\u2010ready screen for sustained\u2010attention instability in spine pain patients. Identifying cognitive vulnerability at the point of care can inform perioperative counselling, driving\/work\u2010safety guidance and rehabilitation planning, and it may help monitor treatment response alongside pain metrics, offering a noninvasive, nonpharmacologic complement to standard pain assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70289","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:09:36Z","timestamp":1778058576000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sustained Attention Instability as a Cognitive Biomarker in Chronic Spine Pain: A 90\u2010second Visual Attention Test"],"prefix":"10.1002","volume":"30","author":[{"given":"Kai\u2010Uwe","family":"Lewandrowski","sequence":"first","affiliation":[{"name":"Department of Orthopedics Hospital Universit\u00e1rio Gaffree Guinle Universidade Federal Do Estado Do Rio de Janeiro  Rio de Janeiro Brazil"},{"name":"Division of Personalized Pain Research and Education Center for Advanced Spine Care of Southern Arizona  Tucson Arizona USA"},{"name":"Department of Orthopedic Surgery University of Arizona Tucson Campus  Tucson Arizona USA"},{"name":"Department of Orthopaedics Fundaci\u00f3n Universitaria Sanitas  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Blum","sequence":"additional","affiliation":[{"name":"Division of Personalized Genomics The Blum Institute of Neurogenetics &amp; Behavior  Austin Texas USA"},{"name":"Department of Psychiatry Case Western Reserve University, School of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Lorio","sequence":"additional","affiliation":[{"name":"Orlando College of Osteopathic Medicine  Winter Garden Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Hanna","sequence":"additional","affiliation":[{"name":"Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology Jacobs School of Medicine and Biosciences, State University of New York at Buffalo  Buffalo New York USA"},{"name":"Department of Psychology State University of New York at Buffalo  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P. L.","family":"Lewandrowski","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences Dornsife College of Letters, Arts &amp; Sciences, University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lundquist","sequence":"additional","affiliation":[{"name":"Brigham Young University  Provo Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossano Kepler Alvim","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Neurology Post\u2010Graduate Program Hospital Universit\u00e1rio Gaffree Guinle, Universidade Federal Do Estado Do Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme J.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Neurology Post\u2010Graduate Program Hospital Universit\u00e1rio Gaffree Guinle, Universidade Federal Do Estado Do Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Liodakis","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfall\u2010, Hand\u2010 Und Wiederherstellungschirurgie  Homburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gold","sequence":"additional","affiliation":[{"name":"Center for Sports, Exercise, and Mental Health, Western University of Health Sciences  Pomona California USA"},{"name":"Department of Psychiatry Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Department of Pharmacology and Toxicology Jacobs School of Medicine and Biomedical Sciences, University at Buffalo  Buffalo New York USA"},{"name":"Department of Psychiatry Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana J.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Neurology 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