Abstract.SignificancePerformance during risky decision making is one of the essential cognitive functions that is impaired in several psychiatric disorders including addiction. However, the cognitive mechanism and neural correlates underlying risky decision making in chronic pain patients are unclear. To our knowledge, this study is among the first to construct computational models to detect the underlying cognitive process of chronic pain patients during risky decision making.AimThis study aimed at inspecting the significantly abnormal risky decision-making patterns of chronic pain patients and its neuro-cognitive correlates.ApproachIn this case-control study, 19 chronic pain patients and 32 healthy controls (HCs) were included to measure the risky decision making in a balloon analogue risk task (BART). Optical neuroimaging using functional near-infrared spectroscopy, together with computational modeling, was carried out to systematically characterize the specific impairments based on BART.ResultsComputational modeling findings on behavioral performance demonstrated that the chronic pain patient group exhibited significant deficits in learning during BART (p<0.001), tending to make decisions more randomly without deliberation (p<0.01). In addition, significant brain deactivation alternation in the prefrontal cortex (PFC) during the task was detected for the patient group compared with that from the control group (p<0.005).ConclusionsLong-term aberrant pain responses significantly disrupted the PFC function and behavioral performance in chronic pain patients. The joint behavioral modeling and neuroimaging techniques open a new avenue for fully understanding the cognitive impairment and brain dysfunction of risky decision making associated with chronic pain.