Attention Modification in Persons with Fibromyalgia: A Double Blind, Randomized Clinical Trial

Abstract

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.

Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance

“…Training early orienting, and not maintained attention, towards neutral words produced significant increases in pain threshold and tolerance, and there was a trend-level reduction in pain severity at 30 s, in comparison with an ABM-Placebo group. Current findings align with studies reporting therapeutic effects of ABM for persistent pain (Carleton et al, 2011;Sharpe et al, 2012Sharpe et al, , 2015Schoth et al, 2013), providing evidence that attentional retraining in early orienting affects fundamental pain processes. Importantly, both studies found a significant impact of ABM-500 on pain threshold, strengthening evidence that the faster bias influences time taken to first register pain.…”

Attention bias modification and its impact on experimental pain outcomes: Comparison of training with words versus faces in pain

“…Similar results were found in a group of fibromyalgia patients, where ABM alone resulted in clinical benefits to patients in comparison to placebo (Carleton et al, 2011) and in a small case series (Schoth et al, 2013). In the chronic pain group, participants received either four sessions of ABM or placebo and then received a standard, eight-session cognitive behaviour therapy (CBT) programme.…”

The role of athletes' pain-related anxiety in pain-related attentional processes

“…Recent research has also shown that changes in attentional biases (i.e., a decrease in vigilance attentional bias) can decrease the symptomatology of anxiety disorder and self-reported pain (e.g., Carleton, Richter, & Asmundson, 2011). These results support the contention that attentional biases may be associated with problems in the development and maintenance of pain.…”