Attentional biases toward sensory pain words in acute and chronic pain patients (original) (raw)
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Modification of attentional biases in chronic pain patients: a preliminary study
2004
Research suggests that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. This study examined the degree to which a successful cognitive-behavioural program was able to reduce the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow-up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre-to post-treatment changes in fear of movement (Tampa Scale for Kinesiophobia) but not other relevant variables, such fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.
The Journal of Pain, 2007
The purpose of this investigation was to clarify mixed findings reported in selective attention investigations. To accomplish this, recently published dot-probe data from 36 patients with chronic musculoskeletal pain and 29 healthy control participants were reanalyzed with consideration of fear of pain (FOP) as a categorical variable. FOP groups were identified by using a variety of strategies and represented differing conceptualizations of the FOP construct. Selective attention for sensory pain, affect pain, and health catastrophe words was assessed by using raw dot-probe detection latencies and the bias, congruency, and incongruency indices. Analysis of the raw detection latencies revealed no significant interactions that permit inferences regarding attentional shifts to or away from specific word types.
Selective attentional bias for pain-related stimuli amongst pain fearful individuals
Pain, 2001
Recent research indicates that people who are fearful of pain tend to report more negative pain experiences. It also seems that attentional mechanisms may be particularly important in the perception of painful stimuli, especially amongst pain fearful individuals. Drawing on a paradigm used to examine biased cognitive processes in the emotional disorders, the current study investigated whether the fear of pain would be related to a greater selective attentional bias in favour of pain-related stimuli. In order to determine the nature of this bias, stimuli material were varied in terms of whether they were related to pain sensations, were related to socially threatening situations or were relatively positive. Those with a high fear of pain exhibited a selective attentional bias towards pain-related information, compared to those classi®ed as low in the fear of pain. No group differences were found for either social threat or positive stimuli. These results indicate that one reason why those with a high fear of pain are particularly susceptible to negative pain experiences could be due to biased attentional processes. Suggestions for cognitive interventions designed to reduce such biases are discussed, as are directions for future research. q
Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain
Pain, 2014
This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n = 22) and 6 (n = 21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought.
PAIN, 1997
Preliminary evidence from a study using a modified Stroop paradigm suggests that individuals with chronic pain selectively attend to pain-related information. The current study was conducted in an attempt to replicate and extend this finding. Nineteen patients with chronic pain stemming from musculoskeletal injury and 22 healthy control subjects participated. All participants completed a computerised task designed to evaluate attentional allocation to cues thematically related to pain and injury via measurement of detection latencies for dotprobes that followed their presentation. Results indicated that patients did not differ from control subjects in their pattern of responses to dot-probes that were presented following either the pain-or injury-related cues. This pattern of results continued to hold true after including level of depression as a covariate in the analysis. However, when patients were divided on the basis of scores on the Anxiety Sensitivity Index (Peterson, R.A. and Reiss, S., Anxiety Sensitivity Index Manual, 2nd edn., International Diagnostic Systems, Worthington, OH, 1992), a measure related to fear of pain (Asmundson, G.J.G. and Norton, G.R., Behav. Res. Ther., 34 (1996) 545-554), those with low anxiety sensitivity shifted attention away from stimuli related to pain whereas those with high anxiety sensitivity responded similarly to dotprobes regardless of the parameters of presentation. These results suggest that the operation of the information processing system in patients with chronic pain may be dependent on a patient's trait predisposition to fear pain. Theoretical and ecological implications are discussed. © 1997 International Association for the Study of Pain. Published by Elsevier Science B.V.
Frontiers in Psychology, 2020
Although the evidence for attentional bias to pain-related information among individuals with chronic pain has been well established, there are a number of inconsistencies in the research that have been observed due to sample characteristics. Therefore, the present study expanded upon previous studies by including patients with a variety of chronic pain conditions and compared a chronic pain patient sample with healthy community sample. We also investigated how pain catastrophizing and other psychological factors in chronic pain patients affected attentional patterns to pain-related information. Forty chronic pain patients from the departments of neurology and rheumatology of an academic medical center hospital and 40 participants without chronic pain from a university that is located in Seoul, South Korea were recruited for the present study. Patients observed pictures of faces displaying pain that were presented simultaneously with faces with neutral expressions, while their eye movements were measured using an eye-tracking system. Independent t-tests were conducted to investigate attentional preferences to pain stimuli between the chronic pain and control groups. No significant attentional differences in pain-neutral pairs were found for both chronic pain and control group. A one-way MANOVA was conducted to examine the role of pain catastrophizing on psychological factors and attentional engagement to pain stimuli. No significant results for the attentional bias to pain stimuli among chronic pain patients may indicate that chronic pain patients who have suffered from chronic pain for a long time and have been treated for their chronic pain in the hospital may interpret pain-related information not as threatening. Clinical implications related to use in pain treatment and future research suggestions are discussed.
Towards a new model of attentional biases in the development, maintenance, and management of pain
Pain, 2015
Individuals with chronic pain demonstrate attentional biases (ABs) towards pain-related stimuli. However, the clinical importance of these biases is yet to be determined and a sound theoretical model for explaining the role of ABs in the development and maintenance of pain is lacking. Within this article, we (1) systematically review prospective and experimental research exploring ABs and pain outcomes in light of current theoretical models and (2) propose a theoretical framework for understanding AB in pain. Across prospective research, an attentional pattern of vigilance-avoidance was observed. Interventions targeting ABs were less consistent; however, there were promising findings among studies that found attentional training effects, particularly for laboratory research. The proposed Threat Interpretation Model suggests a relationship between threat, interpretation, and stimuli in determining attentional processes, which while tentative generates important testable predictions r...
Attention to pain and fear of pain in patients with chronic pain
Journal of Behavioral Medicine, 2013
Objective: to investigate how acceptance of illness affects chronic pain in terms of attention towards pain and fearful thinking of pain. Methods: 62 participants (50 women) with chronic pain carried a palmtop computer for two weeks. Eight times each day auditory signals were delivered to cue participants to complete questions about their experience. Results: Multilevel analyses indicated that on moments with more intense pain, more fearful thinking about pain, and less positive emotions, attention to pain was increased. Illness acceptance did not moderate the relation between pain intensity and attention to pain. Results further indicated that on moments with more intense pain, more negative emotions, and less positive emotions, fearful thinking about pain was increased. Of particular interest was the finding that the relationship between pain intensity and fearful thinking about pain was less strong for those high in acceptance. Conclusions: Pain captures attention and elicits fearful thinking about pain. Acceptance may be a useful avenue to lower negative thinking about pain, and to increase well-being in patients with chronic illnesses.