Attentional bias to pain-related information: A meta-analysis

Abstract

This meta-analysis investigated whether attentional bias, i.e. the preferential allocation of attention to information that is related to pain, is a ubiquitous phenomenon. We also investigated whether attentional bias effects are related to the methodological quality of the study, to procedural differences in their measurement, or to individual differences in pain severity, pain-related fear, anxiety and depression. Results indicated that individuals who experience chronic pain (n=1023) display an attentional bias towards pain-related words or pictures, but this bias was of a small effect size (d=0.134), and did not differ from that in control groups (d=0.082; n=1398). No evidence was found for an attentional bias towards pain-related words and pictures for acute pain (d=0.049), procedural pain (d=0.142), and experimental pain (d=0.069). However, research in which attentional bias towards signals of impending experimental pain in healthy volunteers was investigated, revealed an attentional bias of medium effect size (d=0.676). Moderator analyses in the chronic pain group identified important procedural variables that affected the presence and magnitude of an attentional bias towards pain-related words and pictures, i.e. type INTRODUCTIONAttending toward, dwelling upon, and switching away from pain, have emerged as core components of many cognitive-affective models that seek to explain pain, distress and disability [45,77,154]. Particularly influential is the idea that patients selectively attend to pain at the cost of other information in the environment. This idea has been variably discussed as somatosensory amplification [12,98], hypervigilance [23,35], and more recently as attentional bias [81,120,129,135].The concept of attentional bias was originally introduced by information processing accounts of psychopathology [13,47,92,103]. Attentional bias, or preferentially attending to information that is related to the content of the emotional concerns of patients, has proven to be a robust phenomenon in many forms of psychopathology [21,25,50,117,165]. For example, patients with phobic and anxiety disorders display an attentional bias to threat-related words or pictures [11]. In many of these models biased information processing is not considered epiphenomenal, but instead is invoked as a predisposing, initiating, exacerbating, or maintaining feature of the disorder [11,58,93]. Although much research is correlational, some longitudinal and interventional studies support these accounts [58].Attentional bias to pain-related information is also the subject of significant research activity in pain [4,9,81,120,154,157]. Pain researchers have typically adopted hypotheses and paradigms from psychopathology research. In the first study on this topic, Pearce and Morley (1989) adapted the modified Stroop task, and presented pain patients with cards containing colored words [116]. They instructed participants to name the color of the words while ignoring word meaning. In comparison with control subjects, patients ...

Interrupted by pain: An anatomy of pain-contingent activity interruptions

“…Pain captures attention and urges the person to suspend the ongoing activity and engage in protective actions [14]. The degree to which pain or signals of impending pain capture attention and are evaluated as requiring immediate action is influenced by various factors [11,37]. For example, pursuing a highly valued goal has been found to lower the attentional demand of pain [30].…”

Attentional bias to pain-relevant body locations: New methods, new challenges

“…Recent meta-analyses of such studies showed that attentional bias was overall smaller in magnitude than would have been expected, and that its manifestation was dependent upon specific procedural aspects, such as type of stimuli and presentation time of stimuli (Crombez, Van Ryckeghem, Eccleston, & Van Damme, 2013;Schoth, Nunes, & Liossi, 2012). One potential explanation for these underwhelming results is that visual representations of pain may not sufficiently capture bodily threat, and that the adaptive value of bias to (the location of) such stimuli is very limited Van Damme et al, 2010).…”

Attentional bias and chronic pain: Where to go from here?

“…According to the vigilance-avoidance hypothesis AB towards pain-related information may be found early in time (≤500ms), but may reverse and become attentional avoidance later on (>500ms) [11,12]. As yet, there is no evidence for this idea [5,15].Research on attentional bias has substantially increased during the last years. In doing so, most researchers have adapted experimental paradigms and models of attentional bias from experimental psychopathology.…”

“…Also patients with chronic pain display an AB towards pain-related information, although it is not as robust as is often assumed [5,15]. Despite extant research several challenges remain, and, there is a strong need for systematic investigations in large samples [5].…”

“…In doing so, most researchers have adapted experimental paradigms and models of attentional bias from experimental psychopathology. However, the assumptions that underlie these paradigms and models remain often untested for chronic pain [3,5]. Largely underdeveloped are theoretical accounts of attentional bias that explain how and when AB emerges in chronic pain, and that explicate how exactly AB affects the problems that patients face.…”