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Waisman A, Kleiman V, Slepian PM, Clarke H, Katz J. Autobiographical memory predicts postsurgical pain up to 12 months after major surgery. Pain 2022; 163:2438-2445. [PMID: 35385438 PMCID: PMC9667382 DOI: 10.1097/j.pain.0000000000002645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/20/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Recent cross-sectional studies have identified differences in autobiographical memory (AM) among individuals with chronic pain, but the temporal relationship between the 2 is unknown. Moreover, AM has yet to be studied in patients undergoing major surgery. This study addressed these gaps by conducting a prospective, longitudinal study of memory performance, postsurgical pain, and psychosocial factors in 97 adult participants scheduled for major surgery. Memories were evaluated using the Autobiographical Memory Test before and one month after surgery when participants were asked to recall personal events related to positive and pain-related word cues. Responses were coded for level of specificity, emotional valence, and surgery-related content. Questionnaires assessing presence/absence of pain and psychological functioning were administered before and at 1-, 3-, 6-, and 12-month follow-ups. Generalized estimating equations modelled pain at each postsurgical time point with memory variables as predictors. As hypothesized, higher numbers of specific pain memories recalled before surgery predicted lower odds of pain across all time points (OR = 0.58, 95% CI [0.37-0.91]). Participants who took longer to recall pain memories before surgery (OR = 2.65, 95% CI [1.31-5.37]) and those who produced more surgery-related content at the one-month assessment (OR = 1.31, 95% CI [1.02-1.68]) had greater odds of reporting postsurgical pain up to 12 months later. These findings indicate that presurgical AM biases are risk factors for development and maintenance of postsurgical pain. To the extent that these biases are causal, presurgical interventions that modify the quality and content of patients' memories may prove to be promising strategies in the prevention of chronic postsurgical pain.
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Affiliation(s)
- Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada
| | - Valery Kleiman
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Neurology Specialty Clinic, Altum Health, Toronto Western Hospital, Toronto, ON, Canada
| | - P. Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
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2
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Amaro-Díaz L, Montoro CI, Fischer-Jbali LR, Galvez-Sánchez CM. Chronic Pain and Emotional Stroop: A Systematic Review. J Clin Med 2022; 11:jcm11123259. [PMID: 35743329 PMCID: PMC9224954 DOI: 10.3390/jcm11123259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic pain is an unpleasant sensory and emotional experience that persists for more than 3 months and is often accompanied by symptoms such as depression, fatigue, sleep disturbances, and cognitive impairment. Emotional dysregulation may also be involved in its etiology. Emotions are known to modulate the experience of pain by influencing cognition and behavior (emotional awareness, emotional expression and experience, and verbalizations). A useful task to explore emotional processing and emotional dysregulation is the emotional Stroop task. Despite the large number of studies using this task, their objectives are diverse; it is necessary to integrate them. The main objective of the present systematic review was to determine the extent of the abnormalities in behavioral performance (including attentional biases) and/or brain alterations in patients with chronic pain during the emotional Stroop task. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The protocol was previously registered in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were extracted from the PubMed, Scopus, and Web of Science databases. Fifteen studies were identified as eligible for systematic review. The studies reported alterations in brain regions related to pain and emotional regulation, as well as attentional bias and higher response time latencies (related to the words’ emotional load) in patients with chronic pain. The results confirm the validity of the emotional Stroop task to measure emotions and selective attention. As attentional bias towards negative information is often seen in chronic pain patients, and given the relation between selective attention and greater activation of the brain areas associated with pain and emotional processing, this type of task plays a crucial role in research on emotional and attentional processes among chronic pain patients. Further, attentional bias towards negative information has been associated with higher levels of pain. Taken together, the results suggest the need for cognitive training and an emotional approach to chronic pain therapies, especially targeting attentional biases and negative mood.
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Affiliation(s)
- Lidia Amaro-Díaz
- Department of Psychology, University of Jaén, 23071 Jaén, Spain;
| | - Casandra I. Montoro
- Department of Psychology, University of Jaén, 23071 Jaén, Spain;
- Correspondence: (C.I.M.); (C.M.G.-S.)
| | - Laura R. Fischer-Jbali
- Institute of Psychology, University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | - Carmen M. Galvez-Sánchez
- Department of Psychology, University of Jaén, 23071 Jaén, Spain;
- Correspondence: (C.I.M.); (C.M.G.-S.)
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3
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O’hara R, Sharpe L, Todd J. Cognitive biases among those with frequent or chronic headaches or migraines: a systematic review and meta-analysis. Pain 2021; Publish Ahead of Print. [DOI: 10.1097/j.pain.0000000000002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
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4
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Chan FHF, Suen H, Chan AB, Hsiao JH, Barry TJ. The effects of attentional and interpretation biases on later pain outcomes among younger and older adults: A prospective study. Eur J Pain 2021; 26:181-196. [PMID: 34399011 DOI: 10.1002/ejp.1853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies examining the effect of biased cognitions on later pain outcomes have primarily focused on attentional biases, leaving the role of interpretation biases largely unexplored. Also, few studies have examined pain-related cognitive biases in elderly persons. The current study aims to fill these research gaps. METHODS Younger and older adults with and without chronic pain (N = 126) completed an interpretation bias task and a free-viewing task of injury and neutral scenes at baseline. Participants' pain intensity and disability were assessed at baseline and at a 6-month follow-up. A machine-learning data-driven approach to analysing eye movement data was adopted. RESULTS Eye movement analyses revealed two common attentional pattern subgroups for scene-viewing: an "explorative" group and a "focused" group. At baseline, participants with chronic pain endorsed more injury-/illness-related interpretations compared to pain-free controls, but they did not differ in eye movements on scene images. Older adults interpreted illness-related scenarios more negatively compared to younger adults, but there was also no difference in eye movements between age groups. Moreover, negative interpretation biases were associated with baseline but not follow-up pain disability, whereas a focused gaze tendency for injury scenes was associated with follow-up but not baseline pain disability. Additionally, there was an indirect effect of interpretation biases on pain disability 6 months later through attentional bias for pain-related images. CONCLUSIONS The present study provided evidence for pain status and age group differences in injury-/illness-related interpretation biases. Results also revealed distinct roles of interpretation and attentional biases in pain chronicity. SIGNIFICANCE Adults with chronic pain endorsed more injury-/illness-related interpretations than pain-free controls. Older adults endorsed more illness interpretations than younger adults. A more negative interpretation bias indirectly predicted pain disability 6 months later through hypervigilance towards pain.
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Affiliation(s)
- Frederick H F Chan
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hin Suen
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong
| | - Antoni B Chan
- Department of Computer Science, The City University of Hong Kong, Hong Kong
| | - Janet H Hsiao
- Department of Psychology, The University of Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Tom J Barry
- The Experimental Psychopathology Lab, The University of Hong Kong, Hong Kong.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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5
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Skinner I, Hübscher M, Lee H, Traeger AC, Moseley GL, Wand BM, Gustin SM, McAuley JH. Do people with acute low back pain have an attentional bias to threat-related words? Scand J Pain 2021; 21:485-494. [PMID: 34019753 DOI: 10.1515/sjpain-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES It has been hypothesised that attentional bias to environmental threats can contribute to persistent pain. It is unclear whether people with acute low back pain (LBP) have an attentional bias to environmental threats. We investigated if attentional bias of threat related words is different in people with acute LBP and pain-free controls. METHODS People with acute LBP and pain-free people completed a free viewing eye tracking task. Participants were simultaneously presented with two words, a threat related word and a neutral control word. Threat related words were general threat, affective pain and sensory pain. We conducted linear mixed models to detect differences between acute LBP and pain-free participants on five eye tracking outcome measures (dwell time, first fixation, latency to first fixation, first run dwell time and number of fixations). We calculated absolute reliability, (standard error of measure), and relative reliability (intraclass correlation coefficients [ICC 2,1]) for each eye tracking outcome measures. RESULTS We recruited 65 people with acute LBP and 65 pain-free controls. Participants with acute LBP had a higher proportion of fixations towards the affective pain words (M=0.5009, 95% CI=0.4941, 0.5076) than the pain-free controls had (M=0.4908, 95% CI=0.4836, 0.4979), mean between group difference = -0.0101, 95% CI [-0.0198, -0.0004], p=0.0422. There was no difference between acute LBP and pain-free controls for the remaining eye tracking outcome measures (all p>0.05). The only outcome measure that had an ICC of more than 0.7 was the latency to first fixation (affective pain words ICC=0.73, general threat words ICC=0.72). CONCLUSIONS When compared with pain-free controls, people with acute LBP looked more often at affective pain words relative to neutral control words. This may indicate a form of engagement bias for people with acute LBP. Attentional bias was not consistent across outcome measures or word groups. Further research is needed to investigate the potential role of attentional bias in the development of persistent pain.
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Affiliation(s)
- Ian Skinner
- School of Community Health, Charles Sturt University, Port Macquarie, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Hopin Lee
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Centre for Rehabilitation Research, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adrian C Traeger
- Neuroscience Research Australia, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia, Sydney, NSW, Australia.,IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Sylvia M Gustin
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Jastrowski Mano KE, O'Bryan EM, Gibler RC, Beckmann E. The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model. Clin J Pain 2019; 35:989-1002. [PMID: 31513056 DOI: 10.1097/AJP.0000000000000763] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.
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7
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Chan FHF, Jackson T, Hsiao JH, Chan AB, Barry TJ. The interrelation between interpretation biases, threat expectancies and pain‐related attentional processing. Eur J Pain 2020; 24:1956-1967. [DOI: 10.1002/ejp.1646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Todd Jackson
- Department of Psychology University of Macau China
- Key Laboratory of Cognition and Personality Southwest University Chongqing China
| | - Janet H. Hsiao
- Department of Psychology The University of Hong Kong Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong
| | - Antoni B. Chan
- Department of Computer Science The City University of Hong Kong Hong Kong
| | - Tom J. Barry
- Faculty of Social Sciences The University of Hong Kong Hong Kong
- Institute of Psychiatry, Psychology & Neuroscience King's College London UK
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8
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Hong M, Lee IS, Choi DH, Chae Y. Attentional Bias Toward Cupping Therapy Marks: An Eye-Tracking Study. J Pain Res 2020; 13:1041-1047. [PMID: 32547169 PMCID: PMC7244446 DOI: 10.2147/jpr.s252675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Despite the many medical benefits, cupping therapy can be difficult for some patients due to unpleasant marks on the skin. As patients are afraid of the potential painful sensation from cupping therapy, the skin reactions might produce vigilance for treatment as pain-related information. We investigated whether individuals show negative emotions and attentional bias toward pain-related residual marks from cupping therapy on the body using an eye-tracking method. Methods Fifty pain-free volunteers were presented with four different kinds of visual stimulation, such as the back or face region and with or without cupping marks on the skin. A cupping and a control image were presented on one screen with one image on the left side of the screen and the other on the right (locations of the images were counterbalanced across participants). The eye movements of the participants were measured while they viewed the pictures. They completed the Empathy Quotient questionnaire before the experiment and evaluated the unpleasantness level to each image during the task. Results Images of the back and face with cupping marks were rated significantly more unpleasant and showed a significant attentional bias (significantly longer percentage fixation time) than the control images (attentional bias score: Back + cupping: 48.1 ± 2.8%; Back: -0.7 ± 3.4%; Face + cupping: 34.5 ± 2.5%; Face: -2.2 ± 2.9%). Individuals with greater empathy exhibited significantly higher unpleasantness (r = 0.323, p < 0.05) and less attentional bias (r = -0.279, p < 0.05) to the images with cupping marks. Conclusion The skin reactions caused by cupping therapy evoked negative emotional responses as well as attentional bias to the reaction sites. Our findings suggest that the emotional and attentional responses to cupping therapy might reflect potential reluctance to this therapy.
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Affiliation(s)
- Minyoung Hong
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Seon Lee
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dha-Hyun Choi
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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9
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Schoth DE, Radhakrishnan K, Liossi C. A systematic review with subset meta-analysis of studies exploring memory recall biases for pain-related information in adults with chronic pain. Pain Rep 2020; 5:e816. [PMID: 32440609 DOI: 10.1097/PR9.0000000000000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/08/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Pain-related memory biases have been frequently explored in individuals with chronic pain, and along with attentional and interpretation biases are hypothesised to contribute to the onset and/or maintenance of chronic pain. The aim of this review is to provide a systematic review and synthesis of studies exploring memory recall biases for pain-related information in individuals with chronic pain relative to healthy controls and the recall of neutral information. Studies were identified through a search of Medline, PsychINFO, Web of Science, CINAHL, Cochrane Library, and Open Grey databases. Search terms were memory, recall, recognition, and bias*, intersected with pain. Eighteen studies meeting the inclusion criteria were included. Subset meta-analyses are also reported from 12 studies with relevant between-groups data (comparing recall in chronic pain vs healthy control groups) and 12 studies with relevant within-groups data (eg, comparing recall of pain-related/emotional vs neutral words). Between-groups analysis revealed significantly weaker recall bias for affective-pain words in individuals with chronic pain relative to healthy controls, but only when nondepressed chronic pain individuals were included. No significant differences were found between groups in the recall of sensory-pain, illness-related, or depression-related words. Within-groups analysis revealed individuals with chronic pain show a significant recall bias favouring sensory-pain words relative to neutral and affective-pain words, and a bias for illness-related words relative to depression-related words. A recall bias favouring neutral words was found in healthy individuals. Evidence for the presence of pain-related memory biases in patients with chronic pain is inconclusive. Further methodologically rigorous research is required.
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10
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An J, Wang K, Jung Y, Cho S. Efficacy of Interpretation Bias Modification in Patients With Chronic Pain. The Journal of Pain 2020; 21:648-62. [DOI: 10.1016/j.jpain.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022]
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11
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Chan FHF, Suen H, Hsiao JH, Chan AB, Barry TJ. Interpretation biases and visual attention in the processing of ambiguous information in chronic pain. Eur J Pain 2020; 24:1242-1256. [PMID: 32223046 DOI: 10.1002/ejp.1565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Theories propose that interpretation biases and attentional biases might account for the maintenance of chronic pain symptoms, but the interactions between these two forms of biases in the context of chronic pain are understudied. METHODS To fill this gap, 63 participants (40 females) with and without chronic pain completed an interpretation bias task that measures participants' interpretation styles in ambiguous scenarios and a novel eye-tracking task where participants freely viewed neutral faces that were given ambiguous pain/health-related labels (i.e. 'doctor', 'patient' and 'healthy people'). Eye movements were analysed with the Hidden Markov Models (EMHMM) approach, a machine-learning data-driven method that clusters people's eye movements into different strategy subgroups. RESULTS Adults with chronic pain endorsed more negative interpretations for scenarios related to immediate bodily injury and long-term illness than healthy controls, but they did not differ significantly in terms of their eye movements on ambiguous faces. Across groups, people who interpreted illness-related scenarios in a more negative way also focused more on the nose region and less on the eye region when looking at patients' and healthy people's faces and, to a lesser extent, doctors' faces. This association between interpretive and attentional processing was particularly apparent in participants with chronic pain. CONCLUSIONS In summary, the present study provided evidence for the interplay between multiple forms of cognitive biases. Future studies should investigate whether this interaction might influence subsequent functioning in people with chronic pain.
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Affiliation(s)
| | - Hin Suen
- Department of Psychology, The University of Hong Kong, Hong Kong
| | - Janet H Hsiao
- Department of Psychology, The University of Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Antoni B Chan
- Department of Computer Science, The City University of Hong Kong, Hong Kong
| | - Tom J Barry
- Department of Psychology, The University of Hong Kong, Hong Kong.,Institute of Psychiatry, King's College London, London, UK
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12
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Emerson NM, Meeker TJ, Greenspan JD, Saffer MI, Campbell CM, Korzeniewska A, Lenz FA. Missed targets, reaction times, and arousal are related to trait anxiety and attention to pain during an experimental vigilance task with a painful target. J Neurophysiol 2020; 123:462-472. [PMID: 31596643 PMCID: PMC7052634 DOI: 10.1152/jn.00331.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Although hypervigilance may play a role in some clinical pain syndromes, experimental vigilance toward painful stimuli has been studied infrequently. We evaluated vigilance toward pain by using a continuous performance task (CPT), in which subjects responded to moderately intense painful target stimuli, occurring in a train of mildly painful nontargets. We assessed nondetected targets (misses), reaction times (RTs), and psychological activation (tense arousal). During time on task in CPTs of other sensory modalities, there is an increase in misses and RTs (vigilance decrement). We hypothesized that our CPT would influence vigilance performance related to pain, anxiety, and limitation of attentional resources. The results showed a decrement in vigilance over time as misses increased, although RTs were unchanged. While mind-wandering did not influence vigilance performance, intrinsic attention to pain drove both hit RTs and number of misses. This resulted in pain-focused subjects performing worse on the CPT pain task with slower RTs and more misses per block. During the CPT, the change in stimulus salience was related to the change in pain intensity, while pain unpleasantness correlated with tense arousal. CPT performance during experimental vigilance to pain and psychological activation were related to trait anxiety, as measured by the Spielberger State-Trait Anxiety Inventory and neuroticism, as measured by the NEO five factor inventory. Trait anxiety and neuroticism may play important roles in an individual's predisposition to dwell on pain and interpret pain as threatening.NEW & NOTEWORTHY Subjects detected moderately painful target stimuli in a train of mildly painful nontarget stimuli, which resulted in vigilance performance metrics including missed targets, reaction times, and psychological activation. These performance metrics were related to intrinsic attention to pain and trait anxiety. Subjects with high trait anxiety and neuroticism scores, with a predisposition to attend to pain, had greater tense arousal and poorer vigilance performance, which may be important psychological aspects of vigilance to pain.
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Affiliation(s)
- Nichole M Emerson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Timothy J Meeker
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Joel D Greenspan
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- Department of Neural and Pain Sciences and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, Maryland
| | - Mark I Saffer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Anna Korzeniewska
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Fred A Lenz
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
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14
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Liu X, Wang N, Wang J, Luo F. Formalin-induced and neuropathic pain altered time estimation in a temporal bisection task in rats. Sci Rep 2019; 9:18683. [PMID: 31822729 DOI: 10.1038/s41598-019-55168-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/25/2019] [Indexed: 01/31/2023] Open
Abstract
Time perception is an important ability that is related closely to humans’ and animals’ daily activities. It can be distorted by various emotional states. In human studies, experimental pain has been shown to prolong the perception of time. However, related animal studies are lacking. In this study, we used a temporal bisection task to investigate how acute inflammatory pain (induced by hind-paw formalin injection) and chronic neuropathic pain [induced by spinal nerve ligation (SNL)] affected time perception in rats. Rats were trained to recognize “short” (1200-ms) and “long” (2400-ms) anchor-duration pure tones and were rewarded for corresponding lever presses. During testing, rats perceived a series of intermediate-duration and anchor-duration pure tones, and selected levers corresponding to the “short” and “long” tones. After formalin injection, rats gave more “long” lever-press responses than after saline injection. The point of subjective equality after formalin injection also increased, suggesting that formalin-induced acute pain extended time perception. In contrast, rats that had undergone SNL gave fewer “long” lever-press responses compared with the sham surgery group. This animal study suggests that formalin-induced pain and neuropathic pain may have different effects on time perception.
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15
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Lee J, Beom J, Choi S, Wachholtz SLA, Lee J. Chronic Pain Patients’ Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli. Medicina (B Aires) 2019; 55:530. [PMID: 31450718 PMCID: PMC6780609 DOI: 10.3390/medicina55090530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus. Materials and Methods: Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results: Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs. Conclusions: The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed.
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Adler-Neal AL, Waugh CE, Garland EL, Shaltout HA, Diz DI, Zeidan F. The Role of Heart Rate Variability in Mindfulness-Based Pain Relief. J Pain 2019; 21:306-323. [PMID: 31377215 DOI: 10.1016/j.jpain.2019.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/24/2019] [Accepted: 07/27/2019] [Indexed: 12/30/2022]
Abstract
Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = -.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = -.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques. Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.
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Affiliation(s)
- Adrienne L Adler-Neal
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian E Waugh
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
| | - Eric L Garland
- College of Social Work & Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, Utah
| | - Hossam A Shaltout
- Department of Surgery/Hypertension and Vascular Research, Cardiovascular Sciences Center, Winston-Salem, North Carolina; Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debra I Diz
- Department of Surgery/Hypertension and Vascular Research, Cardiovascular Sciences Center, Winston-Salem, North Carolina
| | - Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Anesthesiology, University of California San Diego, San Diego, California.
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17
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Mazidi M, Dehghani M, Sharpe L, Dolatshahi B, Ranjbar S, Khatibi A. Time course of attentional bias to painful facial expressions and the moderating role of attentional control: an eye-tracking study. Br J Pain 2019; 15:5-15. [PMID: 33633849 DOI: 10.1177/2049463719866877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction This study investigated the time course of attention to pain and examined the moderating effect of attentional control in the relationship between pain catastrophizing and attentional bias in chronic pain patients. Methods A total of 28 patients with chronic pain and 29 pain-free individuals observed pictures of pain, happy and neutral facial expressions while their gaze behaviour was recorded. Pain intensity and duration, anxiety, depression, stress, attentional control and pain catastrophizing were assessed by questionnaires. Results In all subjects, the pattern of attention for pain faces was characterized by initial vigilance, followed by avoidance. No significant difference was found between the two groups in terms of orientation towards the stimuli, the duration of first fixation, the average duration of fixation or number of fixations on the pain stimuli. Attentional control moderated the relationship between catastrophizing and overall dwell time for happy faces in pain patients, indicating that those with high attentional control and high catastrophizing focused more on happy faces, whereas the reverse was true for those with low attentional control. Conclusion This study supported the vigilance-avoidance pattern of attention to painful facial expressions and a moderation effect of attentional control in the association between pain catastrophizing and attentional bias to happy faces among pain patients.
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Affiliation(s)
- Mahdi Mazidi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Centre for the Advancement of Research on Emotion, The University of Western Australia, Crawley, WA, Australia
| | - Mohsen Dehghani
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyran Ranjbar
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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18
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Jackson T, Yang Z, Su L. Pain-related gaze biases and later functioning among adults with chronic pain: a longitudinal eye-tracking study. Pain 2019; 160:2221-8. [DOI: 10.1097/j.pain.0000000000001614] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Schoth DE, Beaney R, Broadbent P, Zhang J, Liossi C. Attentional, interpretation and memory biases for sensory-pain words in individuals with chronic headache. Br J Pain 2019; 13:22-31. [PMID: 30671235 PMCID: PMC6327358 DOI: 10.1177/2049463718789445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cognitive biases in attention, interpretation and less consistently memory have been observed in individuals with chronic pain and play a critical role in the onset and maintenance of chronic pain. Despite operating in combination cognitive biases are typically explored in isolation. AIM The primary aim of this study was to explore attentional, interpretation and memory biases and their interrelationship in individuals with chronic headache. METHODS Twenty-eight participants with chronic headache and 34 healthy controls completed paradigms assessing attentional, interpretation and memory biases with ambiguous sensory-pain and neutral words. RESULTS Individuals with chronic pain showed significantly greater pain-related attentional and interpretation biases relative to controls, with no differences in memory bias. No significant correlation was found between any of the three forms of cognitive bias assessed. DISCUSSION AND CONCLUSION The clinical implications of cognitive biases in individuals with chronic pain remain to be fully explored, although one avenue for future research would be specific investigation of the implications of biased interpretations considering the consistency of results found across the literature for this form of bias.
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Affiliation(s)
- Daniel E Schoth
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Beaney
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Philippa Broadbent
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Jin Zhang
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Christina Liossi
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
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20
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Shires A, Sharpe L, Newton John TRO. The relative efficacy of mindfulness versus distraction: The moderating role of attentional bias. Eur J Pain 2018; 23:727-738. [DOI: 10.1002/ejp.1340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Alice Shires
- School of Psychology University of Sydney Sydney New South Wales Australia
- Clinical Psychology Department, Graduate School of HealthUniversity of Technology Sydney New South Wales Australia
| | - Louise Sharpe
- School of Psychology University of Sydney Sydney New South Wales Australia
| | - Toby R. O. Newton John
- Clinical Psychology Department, Graduate School of HealthUniversity of Technology Sydney New South Wales Australia
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21
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Affiliation(s)
- Jemma Todd
- School of Psychology, University of Sydney, Sydney, Australia
| | - Dimitri M.L. van Ryckeghem
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
- Research Unit INSIDE, Institute for Health and Behaviour; Faculty of Language and Literature, Humanities, Arts and Education, Luxembourg University, Luxembourg City, Luxembourg
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Geert Crombez
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
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22
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Dehghani M, Mohammadi S, Sharpe L, Khatibi A. Attentional Bias to Threat-Related Information Among Individuals With Dental Complaints: The Role of Pain Expectancy. Front Psychol 2018; 9:786. [PMID: 29875723 PMCID: PMC5974166 DOI: 10.3389/fpsyg.2018.00786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/02/2018] [Indexed: 01/08/2023] Open
Abstract
Expecting pain can be perceived as a threat may involve recruitment of cognitive strategies (such as attentional avoidance) which might help the person to reduce distress. The ecological validity of the paradigms aiming to study the attentional biases toward or away from threatening stimuli by manipulating the perception of threat in experimental settings has been questioned. Therefore, the current study aims to investigate the attentional bias toward or away from the threat when a confrontation with a real threatening and painful condition would be expected (i.e., dental treatment). One hundred and twenty-seven patients referred to three dentistry clinics for a dental treatment (experiment participants) and 30 individuals with no dental complaints (control participants) completed this study. Patients were randomly allocated to a high pain expectancy (HPE: n = 65) or a low pain expectancy (LPE: n = 62) expectancy condition. All participants completed questionnaires of distress, fear of pain, and fear of dental pain. Furthermore, they participated in a dot-probe task that assessed their attention to painful faces, dental pictures, and happy faces. In addition, before the treatment, participants reported their anticipated pain intensity and after the treatment, they reported the pain intensity that they perceived during the treatment using two separate visual analog scales. Patients in the HPE group showed a bias away from dental pictures compared to LPE and control group participants. HPE group patients also reported greater pain intensity during the treatment compared to LPE patients. Greater attentional bias away from dental pictures among HPE patients was associated with higher levels of fear of pain, fear of dental pain, and stress. Avoidance of highly salient threatening images can be seen as an unhelpful emotion-regulation strategy that individuals use to manage their fears. However, in this study, avoidance was associated with poorer outcomes.
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Affiliation(s)
- Mohsen Dehghani
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Somayyeh Mohammadi
- GF Strong Rehabilitation Centre, Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Ali Khatibi
- Psychology Department, Bilkent University, Ankara, Turkey.,Interdisciplinary Program in Neuroscience, Sabuncu Brain Research Center, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Sabuncu Brain Research Center, Bilkent University, Ankara, Turkey
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23
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Harvold M, Macleod C, Vaegter HB. Attentional Avoidance is Associated With Increased Pain Sensitivity in Patients With Chronic Posttraumatic Pain and Comorbid Posttraumatic Stress. Clin J Pain 2018; 34:22-9. [DOI: 10.1097/ajp.0000000000000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Mahmoodi-Aghdam M, Dehghani M, Ahmadi M, Khorrami Banaraki A, Khatibi A. Chronic Pain and Selective Attention to Pain Arousing Daily Activity Pictures: Evidence From an Eye Tracking Study. Basic Clin Neurosci 2017; 8:467-478. [PMID: 29942430 PMCID: PMC6010654 DOI: 10.29252/nirp.bcn.8.6.467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction According to the pain research literature, attentional bias for pain is the mechanism responsible for the development and maintenance of fear of pain in patients with chronic pain. However, there is still some debate about the exact mechanism and the role of faster engagement versus difficulty in disengagement in the development of attentional bias. Methods To investigate attentional bias in patients with chronic pain, we used an eye-tracker with the pictures of pain-provoking activities and compared the results with an age- and gender-matched group of pain-free participants. In addition, other measures of pain-related cognition and pain severity ratings were included to assess their contribution to the attentional bias toward pain-related information. Results Calculating the frequency of the first fixations showed that both groups fixated initially on pain-provoking pictures compared to neutral one. Calculating the speed of fixations showed that control participants were faster in fixating on neutral stimuli, but patients with pain were faster in fixating on pain-provoking pictures, indicating a relative vigilance for the pain-related stimuli among them. These patients reported that the intensity of pain in the previous week was positively correlated with the speed of their fixation on the painful stimuli. Conclusion Although these results did not provide unequivocal support for the vigilance-avoidance hypothesis, they are generally consistent with the results of studies using eye tracking technology. Furthermore, our findings put a question over characterization of attentional biases in patients with chronic pain by simply relating that to difficulty in disengaging from pain-related stimuli.
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Affiliation(s)
- Masoumeh Mahmoodi-Aghdam
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Mohsen Dehghani
- Family Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Mehrnoosh Ahmadi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran.,Department of Psychiatry, Roozbeh Psychiatry Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Khatibi
- Department of Psychology, Faculty of Economics, Administrative, and Social Sciences, Bilkent University, Ankara, Turkey.,Interdisciplinary Program in Neuroscience, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
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25
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Skinner IW, Hübscher M, Moseley GL, Lee H, Wand BM, Traeger AC, Gustin SM, Mcauley JH. The reliability of eyetracking to assess attentional bias to threatening words in healthy individuals. Behav Res Methods 2018; 50:1778-92. [DOI: 10.3758/s13428-017-0946-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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26
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Abstract
BACKGROUND Studies have shown that specific cognitions and behaviours play a role in maintaining chronic fatigue syndrome (CFS). However, little research has investigated illness-specific cognitive processing in CFS. This study investigated whether CFS participants had an attentional bias for CFS-related stimuli and a tendency to interpret ambiguous information in a somatic way. It also determined whether cognitive processing biases were associated with co-morbidity, attentional control or self-reported unhelpful cognitions and behaviours. METHOD A total of 52 CFS and 51 healthy participants completed self-report measures of symptoms, disability, mood, cognitions and behaviours. Participants also completed three experimental tasks, two designed specifically to tap into CFS salient cognitions: (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) v. neutral words; (ii) interpretive bias task measuring positive v. somatic interpretations of ambiguous information; and (iii) the Attention Network Test measuring general attentional control. RESULTS Compared with controls, CFS participants showed a significant attentional bias for fatigue-related words and were significantly more likely to interpret ambiguous information in a somatic way, controlling for depression and anxiety. CFS participants had significantly poorer attentional control than healthy individuals. Attention and interpretation biases were associated with fear/avoidance beliefs. Somatic interpretations were also associated with all-or-nothing behaviour and catastrophizing. CONCLUSIONS People with CFS have illness-specific biases which may play a part in maintaining symptoms by reinforcing unhelpful illness beliefs and behaviours. Enhancing adaptive processing, such as positive interpretation biases and more flexible attention allocation, may provide beneficial intervention targets.
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Affiliation(s)
- A M Hughes
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - T Chalder
- Department of Psychological Medicine,King's College London,London,UK
| | - C R Hirsch
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - R Moss-Morris
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
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27
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Brookes M, Sharpe L, Dear B. Rumination induces a pattern of attention characterized by increased vigilance followed by avoidance of affective pain words. Eur J Pain 2017; 21:1197-1208. [DOI: 10.1002/ejp.1020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/09/2022]
Affiliation(s)
- M.L. Brookes
- School of Psychology A18 The University of Sydney NSW Australia
| | - L. Sharpe
- School of Psychology A18 The University of Sydney NSW Australia
| | - B.F. Dear
- Department of Psychology eCentreClinic, Macquarie University Sydney NSW Australia
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28
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Trost Z, Van Ryckeghem D, Scott W, Guck A, Vervoort T. The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample. The Journal of Pain 2016; 17:1207-1216. [DOI: 10.1016/j.jpain.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
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Sharpe L, Brookes M, Jones E, Gittins C, Wufong E, Nicholas M. Threat and fear of pain induces attentional bias to pain words: An eye‐tracking study. Eur J Pain 2016; 21:385-396. [DOI: 10.1002/ejp.936] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- L. Sharpe
- School of Psychology The University of Sydney NSW Australia
| | - M. Brookes
- School of Psychology The University of Sydney NSW Australia
| | - E. Jones
- School of Psychology The University of Sydney NSW Australia
| | - C. Gittins
- School of Psychology The University of Sydney NSW Australia
| | - E. Wufong
- University of Western Sydney NSW Australia
| | - M.K. Nicholas
- Pain Management Research Unit University of Sydney NSW Australia
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30
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Bowler J, Bartholomew K, Kellar I, Mackintosh B, Hoppitt L, Bayliss A. Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance. Eur J Pain 2016; 21:112-124. [DOI: 10.1002/ejp.908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/01/2023]
Affiliation(s)
- J.O. Bowler
- School of Psychology; University of East Anglia; Norwich Norfolk UK
| | - K.J. Bartholomew
- School of Psychology; University of East Anglia; Norwich Norfolk UK
| | - I. Kellar
- School of Psychology; University of Leeds; Leeds UK
| | - B. Mackintosh
- Department of Psychology; University of Essex; Colchester UK
| | - L. Hoppitt
- MRC Cognition and Brain Sciences Unit; Cambridge UK
| | - A.P. Bayliss
- School of Psychology; University of East Anglia; Norwich Norfolk UK
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31
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Todd J, Sharpe L, Colagiuri B, Khatibi A. The effect of threat on cognitive biases and pain outcomes: An eye‐tracking study. Eur J Pain 2016; 20:1357-68. [DOI: 10.1002/ejp.887] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- J. Todd
- School of Psychology University of Sydney NSW Australia
| | - L. Sharpe
- School of Psychology University of Sydney NSW Australia
| | - B. Colagiuri
- School of Psychology University of Sydney NSW Australia
| | - A. Khatibi
- Department of Psychology Bilkent University Ankara Turkey
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32
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Forkmann K, Schmidt K, Schultz H, Sommer T, Bingel U. Experimental pain impairs recognition memory irrespective of pain predictability. Eur J Pain 2015; 20:977-88. [PMID: 26685005 DOI: 10.1002/ejp.822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pain is hardwired to signal threat and tissue damage and therefore automatically attracts attention to initiate withdrawal or defensive behaviour. This well-known interruptive function of pain interferes with cognitive functioning and is modulated by bottom-up and top-down variables. Here, we applied predictable or unpredictable painful heat stimuli simultaneously to the presentation of neutral images to investigate (I) whether the predictability of pain modulated its effect on the encoding of images (episodic memory) and (II) whether subjects remember that certain images have been previously presented with pain (source memory). METHODS Twenty-four healthy subjects performed a categorization task in which 80 images had to be categorized into living or non-living objects. We compared the processing and encoding of these images during cued and non-cued pain trials as well as cued and non-cued pain-free trials. Effects on recognition performance and source memory for pain were immediately tested using a surprise recognition task. RESULTS Painful thermal stimulation impaired recognition accuracy (d', recollection, familiarity). This negative effect of pain was positively correlated with the individual expectation of pain interference and the attentional avoidance of pain-related words. However, the interruptive effect of pain was not modulated by the predictability of pain. Source memory for painful stimulation was at chance level, indicating that subjects did not explicitly remember that images had been paired with pain. CONCLUSIONS Targeting negative expectations and a maladaptive attentional bias for pain-related material might help reducing frequently reported pain-induced cognitive impairments.
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Affiliation(s)
- K Forkmann
- Clinic for Neurology, Essen University Hospital, Germany
| | - K Schmidt
- Clinic for Neurology, Essen University Hospital, Germany
| | - H Schultz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - T Sommer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - U Bingel
- Clinic for Neurology, Essen University Hospital, Germany
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33
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Todd J, Sharpe L, Johnson A, Nicholson Perry K, Colagiuri B, Dear BF. Towards a new model of attentional biases in the development, maintenance, and management of pain. Pain 2015; 156:1589-600. [DOI: 10.1097/j.pain.0000000000000214] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khatibi A, Sharpe L, Jafari H, Gholami S, Dehghani M. Interpretation biases in chronic pain patients: an incidental learning task. Eur J Pain 2014; 19:1139-47. [DOI: 10.1002/ejp.637] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2011] [Indexed: 11/10/2022]
Affiliation(s)
- A. Khatibi
- Laboratory of Research on Neuropsychology of Pain; University of Montreal; Canada
- Rehabilitation Research Centre; Rehabilitation Sciences Faculty; Iran University of Medical Sciences; Tehran Iran
| | - L. Sharpe
- School of Psychology; Clinical Psychology Unit F12; The University of Sydney; Australia
| | - H. Jafari
- Rehabilitation Research Centre; Rehabilitation Sciences Faculty; Iran University of Medical Sciences; Tehran Iran
- Research Group on Health Psychology; University of Leuven (KU Leuven); Belgium
| | - S. Gholami
- Rehabilitation Research Centre; Rehabilitation Sciences Faculty; Iran University of Medical Sciences; Tehran Iran
| | - M. Dehghani
- Family Research Institute; Shahid Beheshti University (G.C.); Tehran Iran
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Priebe J, Messingschlager M, Lautenbacher S. Gaze behaviour when monitoring pain faces: An eye-tracking study. Eur J Pain 2014; 19:817-25. [DOI: 10.1002/ejp.608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- J.A. Priebe
- Department of Physiological Psychology; University of Bamberg; Germany
| | | | - S. Lautenbacher
- Department of Physiological Psychology; University of Bamberg; Germany
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Schoth D, Williams S, Liossi C. Attentional bias for pain- and period-related symptom words in healthy women who experienced a recent painful period. Eur J Pain 2014; 19:745-51. [DOI: 10.1002/ejp.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/11/2022]
Affiliation(s)
- D.E. Schoth
- Academic Unit of Psychology; University of Southampton; UK
| | - S. Williams
- Academic Unit of Psychology; University of Southampton; UK
| | - C. Liossi
- Academic Unit of Psychology; University of Southampton; UK
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Sharpe L. Attentional biases in pain: More complex than originally thought? Pain 2014; 155:439-440. [DOI: 10.1016/j.pain.2013.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 12/31/2022]
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Van Ryckeghem DM, Crombez G. Attentional bias and chronic pain: Where to go from here? Pain 2014; 155:6-7. [DOI: 10.1016/j.pain.2013.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
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