Chronic pain and attention: A cognitive approach

Abstract

The present study draws upon resource-based models of attention in suggesting that the processing of chronic and persistent pain is a task that demands the application of central and executive attention. If a chronic and persistent pain stimulus is demanding of central, attentional resources, it follows that it will compete with a second attention-demanding task for those limited resources. Here it is hypothesized that performance of an attention-demanding interference task will be detrimentally affected by the demands of persistent pain. In Expt 1, patients in high pain, patients in low pain and control subjects without pain performed an attention-demanding numerical interference task. There were no significant differences between any of the groups on any measure of performance. Expt 2 repeated Expt 1 with a more difficult and more complex task. Only when the task was at its most difficult and its most complex (i.e. at the greatest demand of limited resources) did those patients in high levels of pain (i.e. at the greatest demand of limited resources) show performance decrements. The results of both experiments are discussed in relation to the debate concerning the use of cognitive methods for pain control and in relation to the application of cognitive psychology to the study of chronic pain.

Pain and Attention: Attentional Disruption or Distraction?

“…9 Pain is a high-priority signal for danger and threat and therefore draws on limited capacity, which might lead to capacity limits being exceeded and there-…”

“…Reaction times faster than 150 or slower than 1700 milliseconds in the first experiment and 1600 milliseconds in the second experiment were discarded. In line with Eccleston, 9 participants were assigned to the high or low pain intensity group according to their median VAS pain ratings in the painfully cold condition. All participants who scored above the median were assigned to the high pain intensity group, and all participants who scored below the median were assigned to the low pain intensity group.…”

“…9 Pain is a high-priority signal for danger and threat and therefore draws on limited capacity, which might lead to capacity limits being exceeded and there-fore impaired performance. 12 Indeed, several studies have found cognitive impairments in chronic pain patients, [8][9][10][11]15 although some failed to find attentional deficits under pain. 2 Particularly when task difficulty was high, patients in high pain performed worse compared with patients in low pain or pain-free subjects.…”

“…Impaired task performance during experimentally induced pain has been found, 4,5,34,42 yet some studies only found impaired task performance during the anticipation of pain, but not during pain, 41 or even no impairment at all. 18 Eccleston 9 proposed that attention and pain processing might have a bidirectional interaction that depends on the relative ability to capture limited attentional capacity resources. Accordingly, it is important to elucidate the factors that determine the relative extents to which pain interferes with task performance and to which attention to a task modulates pain perception.…”

“…6,7,11,29,35 Second, studies up to now have mainly used tasks in which the difficulty levels were structured in separate blocks to assess the effects of increasing attentional demands, eg, interference tasks. [8][9][10] However, if such blocked tasks are used, subjects can strategically prepare themselves differently to the task at hand. Hence, when no effect of pain on task performance is found, this might not be due to different demands on resources but to different investments of attention to the task.…”