Sustained Attention Instability as a Cognitive Biomarker in Chronic Spine Pain: A 90‐second Visual Attention Test

ABSTRACT Background Chronic spine pain is linked to self‐reported cognitive complaints. However, objective markers are lacking. The 90‐s 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). Objective This study aimed to identify which specific attentional subdomains, measured by the CVAT, are impaired in adults with chronic spine pain. Methods This prospective case–control study included 84 adults with chronic lumbar/cervical pain (≥ 3 months) and 118 healthy controls. A MANCOVA tested group differences on CVAT variables, controlling for age and sex, followed by Bonferroni‐corrected 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. Results The MANCOVA showed a significant group effect (Pillai's Trace = 0.46, F (4,195) = 41.43, p < 0.001). Patients exhibited impairments in all measures p < 0.001 ( η 2 = 0.093–0.44). The VRT deficit persisted when using VRT/RT. Logistic regression identified VRT as the strongest predictor of chronic spine pain ( χ 2 (1) = 147.53, p < 0.001), correctly classifying 86.6% of participants. This finding remained when using VRT/RT ( χ 2 (1) = 130.55, p < 0.001; 82.7% accuracy). Conclusions 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. Level of Evidence III (prospective case–control). Significance Statement A brief, 90‐s computerized attention test provides an objective, clinic‐ready screen for sustained‐attention instability in spine pain patients. Identifying cognitive vulnerability at the point of care can inform perioperative counselling, driving/work‐safety guidance and rehabilitation planning, and it may help monitor treatment response alongside pain metrics, offering a noninvasive, nonpharmacologic complement to standard pain assessment.