What can we learn about selective attention processes in individuals with chronic pain using reaction time tasks? A systematic review and meta-analysis

Abstract

Information-processing biases such as attentional, interpretation, and memory biases are believed to play a role in exacerbating and maintaining chronic pain (CP). Evidence suggests that individuals with CP show attentional bias toward pain-related information. However, the selective attentional processes that underpin this bias are not always well outlined in the literature. To improve current understanding, a systematic review was performed using a descriptive synthesis of reaction time-based studies. A random-effects meta-analysis was added to explore whether the results of previous meta-analyses would be confirmed using studies with a larger sample size. For this review, 2008 studies were screened from 4 databases, of which 34 (participant n = 3154) were included in the review and a subset of 15 (participant n = 1339) were included in the meta-analysis. Review results were summarised by producing a descriptive synthesis for all studies. Meta-analysis results indicated a mild significant attentional bias toward sensory pain-related information (k = 15, g = 0.28, 95% CI [0.16, 0.39], I2 = 43.2%, P = 0.038), and preliminary evidence of significant moderate bias towards affective pain-related information (k = 3, g = 0.48, 95% CI [0.23, 0.72], I2 = 7.1%, P = 0.341) for CP groups compared with control groups. We explored the main tasks, stimuli, and CP subtypes used to address attentional biases and related processes. However, variation across studies did not allow for a decisive conclusion about the role of stimulus, task type, or related attentional processes. In addition, a table of CP attention-related models was produced and tested for reliability. Finally, other results and recommendations are discussed.

Investigating attention toward pain-related cues in an Arabic-speaking population with and without chronic pain

“…The study was pre-registered on the open science framework (OSF) (Abudoush et al 2021) at the beginning of the data collection and before any data had been checked. The Participants were told to respond as quickly as possible according to degree of the color of the target box frame (i.e., pressing "up" key for light green and "down" key for dark green) research was conducted using a hybrid approach; that is, both remote supervised sessions and face-to-face research sessions were used depending on the timing and participant.…”

“…The sample size was calculated according to the critical effect (i.e., the interaction of 3 predictors which are group type, cue condition, and word type) of the Posner task, which has the highest number of factors. Multiple regression model general sample equation was used by comparing sample size in other high-quality studies from a systematic review and meta-analysis conducted by the research team (i.e., 50 + 8 k) (Abudoush et al 2021). To avoid any disruption affecting the study during the COVID-19 pandemic, a twenty-five percent dropout ratio was added to the sample totalling a hundred participants (i.e., 50 for each experimental group arm ;Faul et al 2007).…”

The role of attention bias malleability in experiencing pain and associated disability

“…Contemporary models propose that attentional processing of pain information plays a pivotal role in the development and maintenance of chronic pain ( Todd et al, 2018 ; Van Ryckeghem et al, 2019 ). In particular, it has been suggested that people who exhibit a heightened focus on pain-related information ( i.e., pain-related attention bias) tend to report amplified levels of pain and disability and have a higher likelihood for developing chronic pain see Abudoush et al (2023) and Van Ryckeghem & Crombez (2018) for an overview of theoretical accounts. Furthermore, numerous experimental studies have shown that the level of pain-related attention bias is increased in chronic pain patients compared to healthy volunteers ( Abudoush et al, 2023 ; Crombez et al, 2013 ; Todd et al, 2018 ).…”

“…In particular, it has been suggested that people who exhibit a heightened focus on pain-related information ( i.e., pain-related attention bias) tend to report amplified levels of pain and disability and have a higher likelihood for developing chronic pain see Abudoush et al (2023) and Van Ryckeghem & Crombez (2018) for an overview of theoretical accounts. Furthermore, numerous experimental studies have shown that the level of pain-related attention bias is increased in chronic pain patients compared to healthy volunteers ( Abudoush et al, 2023 ; Crombez et al, 2013 ; Todd et al, 2018 ). Yet, despite these findings, available studies have often failed to show that changes in pain-related attentional bias are key in improving pain outcomes ( Todd et al, 2015 ).…”