Ronessa Dass was awarded the 2024 Research Impact Canada Engaged Scholarship Award for her project, Defining the impacts of brain fog in Veterans with chronic pain.
About Project
What did we study?
Canadian Veterans are twice as likely than civilians to experience chronic pain. Despite a higher likelihood of experiencing chronic pain and comorbid conditions related to their service, veterans experience profound barriers when accessing care for chronic pain. Brain fog, a phenomenon of mental cloudiness associated with functional challenges in cognition and emotion, is one of the least studied symptoms of chronic pain and a potential barrier to pain treatment.
How did we study it?
This project was funded by a capacity building scholarship from the Chronic Pain Centre of Excellence for Canadian Veterans. Using a qualitative descriptive methodology, we first looked at the description of brain fog, using focus groups. We also explored differences in the description of brain fog, across gender. Next, we asked Veterans to complete a survey capturing responses on the Patient Reported Outcomes Measurement Information System Version 29 (PROMIS-29), the Pain Self Efficacy Questionnaire (PSEQ), and the Multiple Abilities Self Report Questionnaire (MASQ). The findings of both studies were converged to identify key considerations for people with lived experiences, healthcare professionals, and researchers. The principles of engaged scholarship were considered throughout this research project and a Veteran partner was consulted to assist with recruitment, selecting relevant constructs and questionnaires, developing the focus group interview guide, analyzing qualitative results, and creating knowledge mobilization products.
What did we find?
We worked with Veterans to create this definition of brain fog: “a phenomenon of fluctuating instances of mental cloudiness. It may produce cognitive and emotional impacts, leading to difficulties with completing daily tasks and goals. The impacts of brain fog can also act reciprocally to reinforce symptoms of brain fog and defer from engagement with evidence based strategies for comorbid conditions” (Dass et al., 2024). Key features of this definition are expanded below. Brain fog can make it harder for people to pay attention, remember, or process their thoughts. It can also affect how people feel, causing feelings of embarrassment, frustration, or sadness. Overall, the cognitive and emotional impacts can make it harder for people to do the activities they value (e.g., grocery shopping, planning vacations, or working) and manage their symptoms; all of which can negatively affect one’s overall health and quality of life. Next, examples of the triggers of brain fog include pain interference, mental health, high cognitive load, and a lack of sleep. In some instances, participants said that brain fog could happen spontaneously. Finally, participants described using strategies like routine, cognitive aids, and having hobbies, however, the impacts of brain fog could make it harder for people to use these strategies.
Key takeaways for people with lived experiences:
- Our definition of brain fog can be used as a tool to describe experiences with healthcare professionals or seek accommodations
Key takeaways for healthcare professionals:
- Brain fog can make it harder for people to engage with pain treatments. For example, treatments like pain neuroscience education require sufficient cognitive capacity. It is important to make treatments accessible by using strategies including the multimodal delivery of educational materials or cognitive reminders.
- In some participants, brain fog could amplify their feelings of mental health and pain, and participants suggested treating brain fog to help mediate other health conditions.
- Women Veterans described unique challenges requiring tailored approaches. They described difficulty prioritizing their own health care needs over other responsibilities like childcare or work. They also described feeling identity strain because of challenges with prioritization and advocated for specific management strategies to help them participate with their daily roles.
Key takeaways for researchers:
- The mechanisms and longitudinal impacts of brain fog are currently unknown and warrant explicit investigation.
- Standardized assessments of brain fog can support the quality and rigour of research exploring brain fog.
Conclusion:
This project has just touched the surface on the impacts of brain fog and highlights the need for future research exploring this experience. As we continue investigating this phenomenon, the information provided can be used as a starting point to 1) increase awareness on this important topic and 2) support people with lived experiences in advocating for access to treatments to manage brain fog. Please feel free to email dassr5@mcmaster.ca (Ronessa Dass) with questions or for access to knowledge products.
Infographics:
About Award Recipient
Ronessa Dass is a MSc student in the School of Rehabilitation Sciences at McMaster University, her thesis was funded by the Chronic Pain Centre of Excellence for Canadian Veterans. She completed her Bachelors’ degree in Cognitive Science, with a concentration in neuroscience, at Carleton University. Her research interests include cognition and chronic pain, EDI, and patient engagement. In her spare time, she is actively involved in the leadership team at the Canadian Pain Society and the Student and Postdoctoral Engagement Committee at the Canadian Institute for Military and Veteran Health Research. Ronessa is excited to continue her work as she returns to McMaster in the fall to a dual MScOT/PhD program.