Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain

Abstract

The aim of this study was to investigate the effects of distraction from pain during and after a pain-inducing lifting task in a sample of chronic low back pain (CLBP) patients. Fifty-two CLBP patients (25 males, 27 females; mean age=46.30 years) performed a pain-inducing lifting task twice, once alone and once with a simultaneous cognitive distraction task. The results revealed that (1) distraction had no effect upon self-reported pain during the lifting task, (2) distraction had a paradoxical effect of more pain immediately after the lifting task, (3) both pain-related fear and pain catastrophizing did not moderate the effects of distraction on pain, but (4) catastrophic thinking about pain during the lifting task was related to more vigilance to pain and less engagement in the distracting task. Further investigation of the catastrophizing data showed that the effect of catastrophizing about pain during the lifting task on the cognitive distraction task was mediated by the amount of attention paid to pain. Clinical implications of these findings are discussed.

The role of motivation in distracting attention away from pain: An experimental study

“…In line with previous research, high catastrophizers in our study reported more attention to pain [20,57] and more negative affect during pain [57]. Our results further showed that distraction was not effective for high catastrophizers in the distraction-only group.…”

“…This task has been successfully used in previous distraction research [20,57]. The RIR-task is an attention-demanding tone-detection task, which requires executive processing.…”

“…RTs faster than 100 ms were considered anticipations and omitted. Outliers (RTs > 3 SD above the individual mean) and omissions were also removed [20,57]. Errors were calculated by summing anticipations and omissions.…”

“…Those who catastrophize about pain, experience pain as threatening, are hypervigilant to pain [9] and have difficulties disengaging attention from pain [55,56]. It is therefore reasonable to assume that pain processing is prioritized over the processing of other information, making it more difficult to engage in a distraction task and as a consequence making distraction less effective [20,21].…”

The role of spatial attention in attentional control over pain: an experimental investigation

“…Most often studies found a reduction in pain experience (McCaul and Malott 1984;Miron et al 1989;Petrovic et al 2000;Tracey et al 2002;Valet et al 2004;Van Damme et al 2008; but see Goubert et al 2004;McCaul et al, 1992). Directing attention away from pain also dampens the processing of nociceptive input in various brain structures (Bantinck et al 2002;Valet et al 2004;Villemure and Bushnell 2009), in particular through the activation of prefrontal areas (Bantinck et al 2002;Petrovic et al 2000;Valet et al 2004).…”