Delay Discounting in Adults With and Without Chronic Pain: Differentiation Across Commodity and Sign

Delay discounting is a component of reward processing that affects decision-making in various health behavior domains. This study examined the discounting of gains and losses for monetary and pain outcomes among adults with and without chronic pain. Pain severity and pain catastrophizing (PC) were examined as additional moderators. This study assessed the discounting rates of 138 adults with chronic pain and 147 adults without chronic pain using online convenience sampling. Delay discounting was measured using an adjusting amount procedure, which titrates discounting rates based on participants’ responses to identify points of indifference. Adults with and without chronic pain discounted losses more than gains and discounted pain outcomes more than monetary outcomes. There were no differences between groups based on chronic pain status or average self-reported pain severity. Post hoc analyses show that, on average, adults with chronic pain and high pain catastrophizing discounted monetary losses less than adults without chronic pain and low pain catastrophizing. This finding suggests that a tendency to defer immediate losses in favor of even larger delayed losses is dependent on high pain catastrophizing in the context of chronic pain. If pain catastrophizing is a more robust predictor of discounting rates than other pain metrics, then catastrophizing may be the construct that predicts risky decision-making.