Pain-related attentional processes: A systematic review of eye-tracking research

Abstract

Biases in the way that people direct their attention towards or away from pain-related information are hypothesised to contribute to the onset and severity of pain-related disorders. This systematic review summarised 24 eye-tracking studies (N = 1424) examining effects of chronic pain, stimulus valence, individual differences in pain-related constructs such as fear of pain and pain catastrophising, and experimentally-induced pain or pain-related threat on attentional processing of visual stimuli. The majority of studies suggest that people with and without chronic pain do not differ in their eye movements on pain-related stimuli, although there is preliminary evidence that gaze biases vary across subtypes of chronic pain and may be evident only for certain stimuli. In contrast, participants with and without chronic pain exhibit a general tendency to allocate more first fixations and total fixations upon pain-related compared to neutral stimuli. Fear of pain was found to have limited effects on eye movements, whereas the tendency to catastrophise about pain, the anticipation of pain, and actual experimental pain stimulation have had stronger associations with eye movements, although results have been mixed. Methodological limitations and future research directions are discussed.

The effects of attentional and interpretation biases on later pain outcomes among younger and older adults: A prospective study

“…A more positive E‐F Scale value for injury scenes (i.e., more focused and less explorative) may indicate a higher tendency to orient towards and maintain on the regions where the injuries were depicted. To further confirm the validity of the E‐F Scale in examining pain‐related attentional bias, we tested its association with traditional eye movement indices that were commonly used in previous eye‐tracking studies (Chan, Suen, et al, 2020; Jones, Sharpe, Andrews, et al, 2021). Since the scene images were presented individually in each trial, we defined an ROI of 100 × 100 pixels for each injury image encompassing the body parts injured and the objects causing the injuries.…”

“…Another critical research gap is that few studies of pain‐related cognitive biases have studied elderly people (Chan et al, 2020). Pain is particularly common during older age and older adults are more vulnerable to chronic and debilitating pain than younger adults (Gibson & Lussier, 2012; Schofield, 2007; Tsang et al, 2008).…”

“…Pain is particularly common during older age and older adults are more vulnerable to chronic and debilitating pain than younger adults (Gibson & Lussier, 2012; Schofield, 2007; Tsang et al, 2008). Despite the importance of studying cognitive biases in young adults, undergraduate students are likely more socioeconomically advantaged, less impaired and less representative of the population with persistent pain complaints (Chan, Suen, et al, 2020). There is therefore a need to investigate information processing in older adults with chronic pain in order to increase the generalizability of this field of research.…”

Examining the Impact of Chronic Pain on Information Processing Behavior: An Exploratory Eye-tracking Study

“…The pain literature suggests that allocation of attention to pain stimuli can reveal the presence of pain experience (Chan et al, 2020). For example, studies show that people in chronic pain often gravitate towards pain stimuli.…”

“…This phenomenon is referred to as pain-related attentional bias and is a major focus of chronic pain literature. Pain-related attentional bias is typically studied via stimulus presentation methods that measure attention by reaction time to pain/non-pain pairs of stimuli, such as sensory words and images (Chan et al, 2020).…”