1
|
Xu T, Vancleef LMG, Peters ML, Van Ryckeghem DML. The Interrelationships Between Cognitive Biases for Pain: An Experimental Study. THE JOURNAL OF PAIN 2024; 25:104587. [PMID: 38834148 DOI: 10.1016/j.jpain.2024.104587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
Contemporary pain models highlight cognitive-processing biases (ie, attention bias [AB], interpretation bias [IB], and memory bias [MB]) as key processes that contribute to poor pain outcomes. However, existing research has yielded inconsistent findings regarding the presence and impact of these biases on pain outcomes. Recognizing the need to explore these biases simultaneously, contemporary pain models suggest that cognitive biases (CBs) are interrelated, and may have a combined impact upon pain problems. The current study aims to investigate the interrelationships between CBs using the PainAIM paradigm, a novel approach enabling simultaneous evaluation of pain-related AB, IB, and MB using cues signaling actual pain rather than symbolic information. We hypothesized the presence and positive associations of biases for pain-related cues and the predictive value of combined AB and IB for poor pain outcomes. Eighty-four healthy participants completed the PainAIM paradigm, followed by a cold pressor task probing pain experience and pain-related task interference. The results indicated an inverse relationship between AB and IB for ambiguous pain cues. In addition, there was a positive association between participants' AB for ambiguous pain and their MB for the same cues. Contrary to our hypotheses, CB indices did not predict experimental pain outcomes. These findings provide support for the interrelationships between pain-related CBs. However, future research on the temporal order of CBs and their combined impact on pain outcomes is needed. By overcoming the limitations associated with traditional paradigms, the PainAIM paradigm offers a promising research tool for the further study of combined CBs in the context of pain. PERSPECTIVE: The current study provides insight into the associations between pain-related CBs (AB, IB, and MB) using ecologically valid (ambiguous) pain cues. The results indicated an inverse association between pain-related AB and IB, while a positive association was found between AB and MB. CBs did however not predict experimental pain outcomes.
Collapse
Affiliation(s)
- Ting Xu
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Linda M G Vancleef
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Madelon L Peters
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dimitri M L Van Ryckeghem
- Section Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; Institute for Health and Behaviour, INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| |
Collapse
|
2
|
Robles E, Blanco I, Díez G, Vázquez C. Mindfulness-based stress reduction for chronic pain: Enhancing psychological well-being without altering attentional biases towards pain faces. Eur J Pain 2024. [PMID: 39180265 DOI: 10.1002/ejp.4714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION This study examines the effects of a Mindfulness-Based Stress Reduction (MBSR) program on psychological measures and attentional patterns to pain stimuli, using eye-tracking methods, in individuals with chronic pain. METHOD Thirty-two participants with chronic pain and no prior mindfulness experience were randomly assigned to an experimental group or a waiting list group. Both groups completed self-report measures of symptoms, well-being, and an attentional disengagement task using emotional faces as stimuli. Assessments were conducted at two points: before and after the intervention for the experimental group, with the waiting list group serving as a control. RESULTS Before the MBSR program, chronic pain participants exhibited significant attentional biases towards pain-related stimuli during early attentional stages. Following the program, significant improvements were observed in depression, anxiety, stress, pain acceptance, overall well-being, and life satisfaction. However, it had a limited impact on attentional patterns, with only a significant increase in gaze duration across all stimuli. DISCUSSION Despite the MBSR program's success in reducing symptoms associated with chronic pain, the lack of broader attentional improvements raises questions about the mechanisms responsible for psychological improvements. SIGNIFICANCE STATEMENT This study pioneers the use of eye-tracking to examine how MBSR influences attention in chronic back pain. While the program improved psychological well-being, it did not generally alter attentional patterns, except for an increased ability to maintain attention across stimuli. We discuss whether this attentional change could be associated with the increased acceptance observed in the MBSR program.
Collapse
Affiliation(s)
- Elena Robles
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Iván Blanco
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Gustavo Díez
- Nirakara Lab, Complutense University of Madrid, Madrid, Spain
| | - Carmelo Vázquez
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
3
|
Zhang Y, Ye Q, He H, Jin R, Peng W. Neurocognitive Mechanisms Underlying Attention Bias Towards Pain: Evidence From a Drift-Diffusion Model and Event-Related Potentials. THE JOURNAL OF PAIN 2023; 24:1307-1320. [PMID: 36921747 DOI: 10.1016/j.jpain.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Although combining computational modeling with event-related potentials (ERPs) can precisely characterize neurocognitive processes involved in attention bias, it has yet to be applied in the context of pain. Here, a hierarchical drift-diffusion model (DDM) along with ERPs was used to characterize the neurocognitive mechanisms underlying attention bias towards pain. A spatial cueing paradigm was adopted, in which the locations of targets were either validly or invalidly predicted by spatial cues related to pain or nonpain signals. DDM-derived nondecision time was shorter for targets validly cued by pain signals than by nonpain signals, thus indicating speeded attention engagement towards pain; drift rate was slower for targets invalidly cued by pain signals than by nonpain signals, reflecting slower attention disengagement from pain. The facilitated engagement towards pain was partially mediated by the enhanced lateralization of cue-evoked N1 amplitudes, which relate to the bottom-up, stimulus-driven processes of detecting threatening signals. On the other hand, the retarded disengagement from pain was partially mediated by the enhanced target-evoked anterior N2 amplitudes, which relate to the top-down, goal-driven processes of conflict monitoring and behavior regulating. These results demonstrated that engagement and disengagement components of pain-related attention bias are governed by distinct neurocognitive mechanisms. However, it remains possible that the findings are not pain-specific, but rather, are related to threat or aversiveness in general. This deserves to be further examined by adding a control stimulus modality. PERSPECTIVE: This study characterized the neurocognitive processes involved in attention bias towards pain through combining a hierarchical DDM and ERPs. Our results revealed distinctive neurocognitive mechanisms underlying engagement and disengagement components of attention bias. Future studies are warranted to examine whether our findings are pain-specific or not.
Collapse
Affiliation(s)
- Yinhua Zhang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Qian Ye
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Hao He
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Richu Jin
- Research Institute of Trustworthy Autonomous Systems, Southern University of Science and Technology, Shenzhen, China; Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Weiwei Peng
- School of Psychology, Shenzhen University, Shenzhen, China.
| |
Collapse
|
4
|
Fernandes-Magalhaes R, Ferrera D, Peláez I, Martín-Buro MC, Carpio A, De Lahoz ME, Barjola P, Mercado F. Neural correlates of the attentional bias towards pain-related faces in fibromyalgia patients: An ERP study using a dot-probe task. Neuropsychologia 2022; 166:108141. [PMID: 34995568 DOI: 10.1016/j.neuropsychologia.2021.108141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND One of the major cognitive deficits in fibromyalgia has been linked to the hypervigilance phenomenon. It is mainly reflected as a negative bias for allocating attentional resources towards both threatening and pain-related information. Although the interest in its study has recently grown, the neural temporal dynamics of the attentional bias in fibromyalgia still remains an open question. METHOD Fifty participants (25 fibromyalgia patients and 25 healthy control subjects) performed a dot-probe task. Two types of facial expressions (pain-related and neutral) were employed as signal stimuli. Then, as a target stimulus, a single dot replaced the location of one of these two faces. Event-related potentials (ERP) in response to facial expressions and target stimulation (i.e., dot) were recorded. Reaction time (RT) and accuracy measures in the experimental task were collected as behavioural outcomes. RESULTS Temporal dynamics of brain electrical activity were analysed on two ERP components (P2 and N2a) sensitive to the facial expressions meaning. Pain-related faces elicited higher frontal P2 amplitudes than neutral faces for the whole sample. Interestingly, an interaction effect between group and facial expressions was also found showing that pain-related faces elicited enhanced P2 amplitudes (at fronto-central regions, in this case) compared to neutral faces only when the group of patients was considered. Furthermore, higher P2 amplitudes were observed in response to pain-related faces in patients with fibromyalgia compared to healthy control participants. Additionally, a shorter latency of P2 (at centro-parietal regions) was also detected for pain-related facial expressions compared to neutral faces. Regarding the amplitude of N2a, it was lower for patients as compared to the control group. Non-relevant effects of the target stimulation on the ERPs were found. However, patients with fibromyalgia exhibited slower RT to locate the single dot for incongruent trials as compared to congruent and neutral trials. CONCLUSIONS Data suggest the presence of an attentional bias in fibromyalgia that it would be followed by a deficit in the allocation of attentional resources to further process pain-related information. Altogether the current results suggest that attentional biases in fibromyalgia might be explained by automatic attentional mechanisms, which seem to be accompanied by an alteration of more strategic or controlled attentional components.
Collapse
Affiliation(s)
- Roberto Fernandes-Magalhaes
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain; Clinical Foundation of the Rey Juan Carlos University, Madrid, Spain
| | - David Ferrera
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | - Alberto Carpio
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - María Eugenia De Lahoz
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Paloma Barjola
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Francisco Mercado
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
| |
Collapse
|
5
|
Gong W, Yi B, Liu X, Luo F. The subsequent interruptive effects of pain on attention. Eur J Pain 2021; 26:786-795. [PMID: 34970813 DOI: 10.1002/ejp.1904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pain is known to interrupt attentional performance selectively. In a previous study we showed that the interruptive effect of thermal pain on attention could persist up to 1500 ms after painful stimulus offset, but whether the pain modality affects this subsequent interruptive effect remains unclear. METHODS The present study was conducted to determine the time course of the interruptive effect of electrically induced pain on orienting and executive attention using various intervals between electric stimulation and attentional tasks (0, 250, 500, 750, 1000, 1250, and 1500 ms) and three study groups (pain, non-pain, and control). We performed two separate experiments in which participants performed a spatial cue task (experiment 1) and the Stroop task (experiment 2). Participants in the pain and non-pain groups received brief electric somatosensory stimulation, and those in the control group received no physical stimulus. We compared the performance of the three groups under the interstimulus interval (ISI) conditions. RESULTS The impairment of orienting attention prevailed under the first six ISI conditions in the pain and non-pain groups (F2, 63 = 5.72, P < 0.01); executive attention was not affected (F1,66 = 1.64, P = 0.20), confirming the persistence of the interruptive effect after stimulus offset. CONCLUSIONS This study demonstrated the interruptive effect of somatic stimulation on subsequent orienting attention performance, with no effect on executive attention. These findings suggest that pain has differential effects on the components of attention, depending on its modality and salience.
Collapse
Affiliation(s)
- Wenxiao Gong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, P.R. China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, P.R. China
| | - Bing Yi
- Department of Psychology, Renmin University of China, Beijing, 100872, P.R. China
| | - Xiaoqian Liu
- School of Sociology, China University of Political Science and Law, Beijing, 100088, P.R. China
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, P.R. China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, P.R. China
| |
Collapse
|
6
|
Gong W, Li J, Luo F. Time Course of Attention Interruption After Transient Pain Stimulation. THE JOURNAL OF PAIN 2020; 21:1247-1256. [PMID: 32553619 DOI: 10.1016/j.jpain.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/08/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
Although pain has been shown to affect attentional performance, little is known about the time course of attention interruption after pain stimulus perception. The present study examined the time course of the effects of transient heat pain stimulation on 2 components of attention. Three groups of subjects performed attention tasks under pain, warmth, and no-stimulation control conditions, respectively. The pain and warmth groups received brief physical stimulation. Attention tasks were presented 0 ms, 250 ms, 750 ms, or 1500 ms after the end of stimulation. The 2 attention tasks, namely the spatial cue task (Experiment 1, N = 92) and a Stroop task (Experiment 2, N = 86), were conducted separately. In Experiment 1, attentional orientation of the pain and warmth groups was significantly impaired for at least 1.5 seconds after the physical stimulation had ended. Interestingly, this effect lasted longer for the warmth group than for the pain group. In Experiment 2, pain stimulation had no effect on executive attention at any time. We concluded that attentional orientation is selectively disrupted by both pain and warmth stimuli, but recovers earlier from pain. PERSPECTIVE: This article is concerned with the subsequent interruptive effect of pain on attentional orientation and executive attention by using the spatial cue task and the Stroop task, respectively. These measures offer options for investigating the time course of attention interruption after transient pain stimulation.
Collapse
Affiliation(s)
- Wenxiao Gong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Jifang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China; Sino-Danish Center for Education and Research, Beijing, PR China
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China.
| |
Collapse
|
7
|
Labrenz F, Knuf-Rtveliashvili S, Elsenbruch S. Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model. Front Psychiatry 2020; 11:197. [PMID: 32265756 PMCID: PMC7105724 DOI: 10.3389/fpsyt.2020.00197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
Although the broad role of fear and hypervigilance in conditions of the gut-brain axis like irritable bowel syndrome is supported by converging evidence, the underlying mechanisms remain incompletely understood. Even in healthy individuals, it remains unclear how pain-related fear may contribute to pain-related attentional biases for acute visceral pain. Building on our classical fear conditioning work in a clinically relevant model of visceral pain, we herein elucidated pain-related attentional biases shaped by associative learning in healthy women and men, aiming to elucidate possible sex differences and the role of psychological traits. To this end, we compared the impact of differentially conditioned pain-predictive cues on attentional biases in healthy women and men. Sixty-four volunteers accomplished a visual dot-probe task and subsequently underwent pain-related fear conditioning where one visual cue (CS+) was contingently paired with a painful rectal distention (US) while another cue remained unpaired (CS-). During the following test phase, the dot-probe task was repeated to investigate changes in attentional biases in response to differentially valenced cues. While pain-related learning was comparable between groups, men revealed more pronounced attentional engagement with the CS+ and CS- whereas women demonstrated stronger difficulties to disengage from the CS+ when presented with a neutral cue. However, when both CS+ and CS- were presented together, women revealed stronger difficulties to disengage from the CS-. Regression analyses revealed an interaction of sex, with negative affect predicting stronger avoidance of the CS+ and stronger difficulties to disengage attention from the CS- in men. These results provide first evidence that pain-related fear conditioning may induce attentional biases differentially in healthy women and men. Hence, sex differences may play a role in attentional mechanisms underlying hypervigilance, and may be modulated by psychological vulnerability factors relevant to chronic visceral pain.
Collapse
Affiliation(s)
- Franziska Labrenz
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sopiko Knuf-Rtveliashvili
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
8
|
Gong W, Fan L, Luo F. Does experimentally induced pain affect attention? A meta-analytical review. J Pain Res 2019; 12:585-595. [PMID: 30787635 PMCID: PMC6368116 DOI: 10.2147/jpr.s184183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recent studies have found that clinical pain is related to cognitive impairment. However, there remains a scarcity of systematic reviews on the influence of acute pain on attention. Laboratory-induced pain is often used to simulate acute pain. The current systematic meta-analysis aimed to evaluate the effect of induced-pain on three components of attention (orienting, alerting, and executive attention) in healthy subjects. Methods A systematic search of three databases was performed. Only data from studies that administered laboratory-induced pain and that also included a control group were selected. The effects of experimental pain on orienting attention, alerting attention, and executive attention were analyzed. Two reviewers assessed the studies and extracted relevant data according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. Results Eight studies were included in the meta-analysis. Orienting attention was marginally interrupted by pain under the invalid cue and marginally facilitated by pain under the valid cue condition. Performance on alerting attention was decreased by pain. Executive attention was not significantly affected by pain. Conclusion There was moderate evidence that experimentally induced pain can produce effects on orienting and alerting attention but not on executive attention. This meta-analysis suggests that experimentally induced pain influences some aspects of attention.
Collapse
Affiliation(s)
- Wenxiao Gong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, People's Republic of China, .,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China,
| | - Lu Fan
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, People's Republic of China, .,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China,
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, People's Republic of China, .,Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China,
| |
Collapse
|
9
|
Vuong QC, Owen A, Akin-Akinyosoye K, Araujo-Soares V. An incremental dual-task paradigm to investigate pain attenuation by task difficulty, affective content and threat value. PLoS One 2018; 13:e0207023. [PMID: 30412604 PMCID: PMC6226192 DOI: 10.1371/journal.pone.0207023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023] Open
Abstract
There is accumulating evidence that task demands and psychological states can affect perceived pain intensity. Different accounts have been proposed to explain this attenuation based either on how limited attentional resources are allocated to the pain stimulus or on how the threat value of the pain stimulus biases attention. However, the evidence for both proposals remains mixed. Here we introduce an incremental dual-task paradigm in which participants were asked to detect pain on their fingertip without any additional tasks during baseline phases or while concurrently detecting visual targets during task phases. The force applied to participants' fingertip in all phases increased incrementally until they detected moderate pain. In Experiment 1, we used coloured shapes and in Experiment 2 we used affective images as visual targets. We also manipulated the threat value of the pain stimulus in Experiment 2. For both experiments, we found that a concurrent task attenuated perceived pain intensity: mean force was significantly greater for the same moderate pain during task compared to baseline phases. Furthermore although task difficulty and affective content did not affect pain perception, the threat value of the pain stimulus moderated the magnitude of pain attenuation.
Collapse
Affiliation(s)
- Quoc C. Vuong
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Angela Owen
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Vera Araujo-Soares
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
10
|
Schrooten MG, Van Damme S, Crombez G, Kindermans H, Vlaeyen JW. Winning or not losing? The impact of non-pain goal focus on attentional bias to learned pain signals. Scand J Pain 2018; 18:675-686. [DOI: 10.1515/sjpain-2018-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/11/2018] [Indexed: 12/22/2022]
Abstract
Abstract
Background and aims
Insights into the nature of cognitive bias, including attentional bias to threat signals, are considered pivotal to understanding (chronic) pain and related distress. It has been put forward that attention to pain-related threat is normally dynamic and relates to the motivational state of the individual. In this experiment we aimed (i) to replicate the finding that attentional bias for pain signals in healthy participants can be reduced when a non-pain goal is pursued, and (ii) to extend this finding by taking into account the outcome focus of the non-pain goal. We hypothesised that the reduction in attentional bias for pain signals by concurrent non-pain goal pursuit would be stronger with non-pain prevention goals than with promotion goals.
Methods
Healthy university students performed an attentional bias task (i.e. spatial cueing task) containing visual cues that signalled the possible occurrence of a painful stimulus (electrocutaneous stimulus at tolerance level) or its absence, in combination with a non-pain goal task (i.e. digit naming task). The non-pain goal was either related to acquiring a positive outcome (gaining money depending on digit-naming performance; promotion goal group, n=31) or related to avoiding a negative outcome (losing money; prevention goal group, n=31). A standard attentional bias task served as the control condition (control group, n=31).
Results
Spatial cueing effects were larger for pain cues than for no-pain cues, indicating attentional bias for pain signals. The pattern of results suggests that this effect was indeed reduced in the goal groups as compared to the control group, but there was no significant group difference.
Conclusions
We found no statistically-significant evidence for the impact of non-pain goal pursuit or outcome focus on pain-related attentional bias. At best, there were indications of a reduced attentional bias for pain signals with non-pain goal pursuit that was either promotion- or prevention focused.
Implications
These data add to the small but growing body of literature on the assumed relevance of motivational context in explaining variations in attentional bias. The results trigger new questions on the nature and assessment of pain-related attentional bias, and more specifically attentional bias for fear-conditioned pain signals (versus safety signals), from a motivational perspective.
Collapse
Affiliation(s)
- Martien G.S. Schrooten
- Örebro University , School of Law, Psychology and Social Work, Center for Health and Medical Psychology (CHAMP) , Box 1252, 70112 Örebro , Sweden
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
- Centre for Pain Research , University of Bath , Bath , UK
| | - Hanne Kindermans
- Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
| | - Johan W.S. Vlaeyen
- Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
- Research Group on Health Psychology , University of Leuven , Leuven , Belgium
| |
Collapse
|
11
|
Vossen CJ, Luijcks R, van Os J, Joosten EA, Lousberg R. Does pain hypervigilance further impact the lack of habituation to pain in individuals with chronic pain? A cross-sectional pain ERP study. J Pain Res 2018; 11:395-405. [PMID: 29497330 PMCID: PMC5822847 DOI: 10.2147/jpr.s146916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM In chronic pain, habituation is believed to be impaired, and pain hypervigilance can enhance the pain experience. The goal of this study was to determine whether pain hypervigilance further worsens habituation of event-related potentials, measured in a pain-rating protocol of 25 painful somatosensory electrical stimuli, in patients with chronic pain. METHODS Pain hypervigilance was assessed with the Pain Vigilance Awareness Questionnaire and analyzed using the event-related fixed interval areas multilevel technique, which enables one to study within-session habituation. In a cohort of 111 participants, 33 reported chronic pain. This chronic pain group was compared with 33 pain-free individuals, matched for age and sex. RESULTS The relationship between pain status and habituation was not moderated by pain hypervigilance. Chronic pain status affected linear habituation and dishabituation (quadratic function) from 220 to 260 ms for nearly all electrodes, and from 580 to 640 ms for frontal electrodes. The effect of pain hypervigilance on habituation was observed primarily from 480 to 820 ms poststimulus for right-sided and central electrodes. CONCLUSION Pain hypervigilance and chronic pain independently influence habituation to painful stimuli - although not synergistically. To confirm that these effects are mediated by separate pathways, further research is required, in which electroencephalography is combined with other modalities with adequate spatial resolution, such as functional magnetic resonance imaging.
Collapse
Affiliation(s)
| | - Rosan Luijcks
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | | | - Richel Lousberg
- Department of Psychiatry & Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
12
|
Jackson T, Su L, Wang Y. Effects of higher versus lower threat contexts on pain-related attention biases: An eye-tracking study. Eur J Pain 2018; 22:1113-1123. [DOI: 10.1002/ejp.1195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 11/09/2022]
Affiliation(s)
- T. Jackson
- Key Laboratory of Cognition and Personality; Southwest University; Chongqing China
- Department of Psychology; University of Macau; China
| | - L. Su
- Key Laboratory of Cognition and Personality; Southwest University; Chongqing China
| | - Y. Wang
- Key Laboratory of Cognition and Personality; Southwest University; Chongqing China
| |
Collapse
|
13
|
Schmidt K, Gamer M, Forkmann K, Bingel U. Pain Affects Visual Orientation: an Eye-Tracking Study. THE JOURNAL OF PAIN 2018; 19:135-145. [DOI: 10.1016/j.jpain.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/04/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
|
14
|
Internet-Delivered Cognitive Behavior Therapy for Adolescents With Irritable Bowel Syndrome: A Randomized Controlled Trial. Am J Gastroenterol 2017; 112:152-162. [PMID: 27845338 DOI: 10.1038/ajg.2016.503] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Few treatments have been able to effectively manage pediatric irritable bowel syndrome (IBS). Internet-delivered cognitive behavior therapy (Internet-CBT) based on exposure for abdominal symptoms is effective for adult IBS. The objective of this study was to evaluate the efficacy of Internet-CBT based on behavioral exposure for adolescents with IBS. METHODS Adolescents with IBS fulfilling the Rome III criteria were randomized to either Internet-CBT or a wait-list control. The Internet-CBT was a 10-week intervention where the main component was exposure to IBS symptoms by reduction of avoidance of abdominal symptoms and instead stepwise provocation of symptoms. The primary outcome was total score on Gastrointestinal Symptoms Rating Scale for IBS (GSRS-IBS). Secondary outcomes included adolescent- and parent-rated quality of life and parent-rated gastrointestinal symptoms. Difference between groups was assessed from pretreatment to posttreatment and the Internet-CBT group was also evaluated at 6 months after treatment completion. RESULTS A total of 101 adolescents with IBS (13-17 years of age) were included in this study. Dropout rates were low (6%) and all randomized patients were included in intent-to-treat analyses based on mixed effects models. Analyses showed a significant larger pretreatment to posttreatment change on the primary outcome GSRS-IBS (B=-6.42, P=0.006, effect size Cohen's d=0.45, 95% confidence interval (0.12, 0.77)) and on almost all secondary outcomes for the Internet-CBT group compared with the control group. After 6 months, the results were stable or significantly improved. CONCLUSIONS Internet-CBT based on exposure exercises for adolescents with IBS can effectively improve gastrointestinal symptoms and quality of life.
Collapse
|
15
|
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] [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
| |
Collapse
|
16
|
Towards a new model of attentional biases in the development, maintenance, and management of pain. Pain 2015; 156:1589-1600. [DOI: 10.1097/j.pain.0000000000000214] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Zheng C, Wang JY, Luo F. Painful faces-induced attentional blink modulated by top-down and bottom-up mechanisms. Front Psychol 2015; 6:695. [PMID: 26082731 PMCID: PMC4450588 DOI: 10.3389/fpsyg.2015.00695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/11/2015] [Indexed: 12/04/2022] Open
Abstract
Pain-related stimuli can capture attention in an automatic (bottom–up) or intentional (top–down) fashion. Previous studies have examined attentional capture by pain-related information using spatial attention paradigms that involve mainly a bottom–up mechanism. In the current study, we investigated the pain information-induced attentional blink (AB) using a rapid serial visual presentation (RSVP) task, and compared the effects of task-irrelevant and task-relevant pain distractors. Relationships between accuracy of target identification and individual traits (i.e., empathy and catastrophizing thinking about pain) were also examined. The results demonstrated that task-relevant painful faces had a significant pain information-induced AB effect, whereas task-irrelevant faces showed a near-significant trend of this effect, supporting the notion that pain-related stimuli can influence the temporal dynamics of attention. Furthermore, we found a significant negative correlation between response accuracy and pain catastrophizing score in task-relevant trials. These findings suggest that active scanning of environmental information related to pain produces greater deficits in cognition than does unintentional attention toward pain, which may represent the different ways in which healthy individuals and patients with chronic pain process pain-relevant information. These results may provide insight into the understanding of maladaptive attentional processing in patients with chronic pain.
Collapse
Affiliation(s)
- Chun Zheng
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing China ; University of Chinese Academy of Sciences, Beijing China ; Department of Psychology, Southwest University for Nationalities, Chengdu China
| | - Jin-Yan Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing China
| | - Fei Luo
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing China
| |
Collapse
|
18
|
Associative fear learning and perceptual discrimination: A perceptual pathway in the development of chronic pain. Neurosci Biobehav Rev 2015; 51:118-25. [DOI: 10.1016/j.neubiorev.2015.01.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 12/11/2014] [Accepted: 01/09/2015] [Indexed: 12/30/2022]
|
19
|
Trying to Fix a Painful Problem: The Impact of Pain Control Attempts on the Attentional Prioritization of a Threatened Body Location. THE JOURNAL OF PAIN 2015; 16:135-43. [DOI: 10.1016/j.jpain.2014.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 12/19/2022]
|
20
|
Affiliation(s)
- Michael K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| |
Collapse
|
21
|
He CH, Yu F, Jiang ZC, Wang JY, Luo F. Fearful thinking predicts hypervigilance towards pain-related stimuli in patients with chronic pain. Psych J 2014; 3:189-200. [PMID: 25197552 DOI: 10.1002/pchj.57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive impairment plays a role in the development and maintenance of chronic pain. Patients with painful disorders are reported to show attentional biases toward pain-related information. However, these findings are controversial, and rarely has any study examined whether chronic pain patients have attentional biases to pain-related conditioned stimuli (CS). In this study, twenty-one patients diagnosed with trigeminal neuralgia (TN) were recruited from the neurosurgical department of a large urban general hospital. Sixteen family members and twenty-one pain-free volunteers were included as two separate control groups. Pain ratings, pain-related anxiety, general anxiety, and depression were measured in all subjects using questionnaires. Two dot probe tests were performed, one that used pictures of painful versus neutral faces as cues, and another that presented three types of CS as cues that predicted certain, uncertain, or no pain. Our results demonstrate that the TN patients showed attentional biases towards painful faces and the CSs that signaled uncertain pain. Moreover, the ratings of negative emotion about their pain conditions correlated significantly with the presence of attentional biases. The patients' close family members, however, displayed biases towards uncertain-pain CS. This study demonstrates that patients with chronic pain have increased attention towards pain-related information, and the fearful thinking about pain was positively correlated with this phenomenon.
Collapse
Affiliation(s)
- Chun-Hong He
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China ; University of Chinese Academy of Sciences, Beijing, China
| | - Feng Yu
- Department of Neurosurgery, Chinese PLA General Hospital of Jinan Military Command, Jinan, Shandong province, China
| | - Zhao-Cai Jiang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China ; University of Chinese Academy of Sciences, Beijing, China
| | - Jin-Yan Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Fei Luo
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
22
|
Liossi C, Schoth DE, Godwin HJ, Liversedge SP. Using eye movements to investigate selective attention in chronic daily headache. Pain 2014; 155:503-510. [DOI: 10.1016/j.pain.2013.11.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 11/15/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022]
|
23
|
Elman I, Borsook D, Volkow ND. Pain and suicidality: insights from reward and addiction neuroscience. Prog Neurobiol 2013; 109:1-27. [PMID: 23827972 PMCID: PMC4827340 DOI: 10.1016/j.pneurobio.2013.06.003] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/03/2013] [Accepted: 06/18/2013] [Indexed: 01/09/2023]
Abstract
Suicidality is exceedingly prevalent in pain patients. Although the pathophysiology of this link remains unclear, it may be potentially related to the partial congruence of physical and emotional pain systems. The latter system's role in suicide is also conspicuous during setbacks and losses sustained in the context of social attachments. Here we propose a model based on the neural pathways mediating reward and anti-reward (i.e., allostatic adjustment to recurrent activation of the reward circuitry); both are relevant etiologic factors in pain, suicide and social attachments. A comprehensive literature search on neurobiology of pain and suicidality was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) physical and emotional pain, (2) emotional pain and social attachments, (3) pain- and suicide-related alterations of the reward and anti-reward circuits as compared to addiction, which is the premier probe for dysfunction of these circuits and (4) mechanistically informed treatments of co-occurring pain and suicidality. Pain-, stress- and analgesic drugs-induced opponent and proponent states of the mesolimbic dopaminergic pathways may render reward and anti-reward systems vulnerable to sensitization, cross-sensitization and aberrant learning of contents and contexts associated with suicidal acts and behaviors. These findings suggest that pain patients exhibit alterations in the brain circuits mediating reward (depressed function) and anti-reward (sensitized function) that may affect their proclivity for suicide and support pain and suicidality classification among other "reward deficiency syndromes" and a new proposal for "enhanced anti-reward syndromes". We suggest that interventions aimed at restoring the balance between the reward and anti-reward networks in patients with chronic pain may help decreasing their suicide risk.
Collapse
Affiliation(s)
- Igor Elman
- Providence VA Medical Center and Cambridge Health Alliance, Harvard Medical School, 26 Central Street, Somerville, MA 02143, USA.
| | | | | |
Collapse
|
24
|
Bardel MH, Woodman T, Perreaut-Pierre E, Barizien N. The role of athletes' pain-related anxiety in pain-related attentional processes. ANXIETY STRESS AND COPING 2013; 26:573-83. [DOI: 10.1080/10615806.2012.757306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Nicholas MK, Asghari A, Sharpe L, Brnabic A, Wood BM, Overton S, Tonkin L, de Sousa M, Finniss D, Beeston L, Sutherland A, Corbett M, Brooker C. Cognitive exposure versus avoidance in patients with chronic pain: adherence matters. Eur J Pain 2013; 18:424-37. [PMID: 23939595 DOI: 10.1002/j.1532-2149.2013.00383.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Behavioural exposure methods can reduce pain-avoidance behaviours, but outcomes vary. One possible explanation is that patients employ cognitive (experiential) avoidance during behavioural exposure. If so, reducing cognitive avoidance during behavioural exposure should help. One option is interoceptive exposure (IE), which involves sustained exposure (via attention) to pain sensations. In order to test if IE could improve outcomes from behavioural exposure, this study with mixed chronic pain patients compared outcomes from a cognitive behavioural therapy (CBT) pain management programme incorporating either IE or distraction from pain. METHODS One hundred forty chronic pain patients were randomly assigned to CBT + IE or CBT + distraction. Outcome measures included pain, disability, depression and medication. Measures reflecting degree of threat of pain were also employed (catastrophizing, fear-avoidance, pain self-efficacy and pain acceptance). An intention-to-treat approach, using mixed-effects model repeated measures, as well as conventional inferential statistical tests, effect sizes and reliable change indices were employed to evaluate the outcomes up to 1-year post-treatment. RESULTS Significant improvements were achieved by both treatment conditions on all outcome measures and on measures reflecting the threatening nature of pain, with no differences between treatment conditions. CONCLUSIONS The addition of IE to behavioural exposure did not improve outcomes. However, higher adherence to either attentional strategy was associated with larger effect sizes on all measures, suggesting factors shared by the two treatments could have contributed to the outcomes. Taken as a whole, the results suggest that increasing adherence to treatment strategies, possibly by motivational measures, would improve the overall outcomes of these interventions.
Collapse
Affiliation(s)
- M K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Crombez G, Van Ryckeghem DM, Eccleston C, Van Damme S. Attentional bias to pain-related information: A meta-analysis. Pain 2013; 154:497-510. [DOI: 10.1016/j.pain.2012.11.013] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/15/2012] [Accepted: 11/21/2012] [Indexed: 12/22/2022]
|
27
|
Van Ryckeghem DM, Crombez G, Goubert L, De Houwer J, Onraedt T, Van Damme S. The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study. Pain 2013; 154:468-475. [DOI: 10.1016/j.pain.2012.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
|
28
|
Kattoor J, Gizewski ER, Kotsis V, Benson S, Gramsch C, Theysohn N, Maderwald S, Forsting M, Schedlowski M, Elsenbruch S. Fear conditioning in an abdominal pain model: neural responses during associative learning and extinction in healthy subjects. PLoS One 2013; 8:e51149. [PMID: 23468832 PMCID: PMC3582635 DOI: 10.1371/journal.pone.0051149] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/29/2012] [Indexed: 12/17/2022] Open
Abstract
Fear conditioning is relevant for elucidating the pathophysiology of anxiety, but may also be useful in the context of chronic pain syndromes which often overlap with anxiety. Thus far, no fear conditioning studies have employed aversive visceral stimuli from the lower gastrointestinal tract. Therefore, we implemented a fear conditioning paradigm to analyze the conditioned response to rectal pain stimuli using fMRI during associative learning, extinction and reinstatement. In N = 21 healthy humans, visual conditioned stimuli (CS+) were paired with painful rectal distensions as unconditioned stimuli (US), while different visual stimuli (CS−) were presented without US. During extinction, all CSs were presented without US, whereas during reinstatement, a single, unpaired US was presented. In region-of-interest analyses, conditioned anticipatory neural activation was assessed along with perceived CS-US contingency and CS unpleasantness. Fear conditioning resulted in significant contingency awareness and valence change, i.e., learned unpleasantness of a previously neutral stimulus. This was paralleled by anticipatory activation of the anterior cingulate cortex, the somatosensory cortex and precuneus (all during early acquisition) and the amygdala (late acquisition) in response to the CS+. During extinction, anticipatory activation of the dorsolateral prefrontal cortex to the CS− was observed. In the reinstatement phase, a tendency for parahippocampal activation was found. Fear conditioning with rectal pain stimuli is feasible and leads to learned unpleasantness of previously neutral stimuli. Within the brain, conditioned anticipatory activations are seen in core areas of the central fear network including the amygdala and the anterior cingulate cortex. During extinction, conditioned responses quickly disappear, and learning of new predictive cue properties is paralleled by prefrontal activation. A tendency for parahippocampal activation during reinstatement could indicate a reactivation of the old memory trace. Together, these findings contribute to our understanding of aversive visceral learning and memory processes relevant to the pathophysiology of chronic abdominal pain.
Collapse
Affiliation(s)
- Joswin Kattoor
- Inst. of Medical Psychology & Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Elke R. Gizewski
- Clinic of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - Vassilios Kotsis
- Inst. of Medical Psychology & Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Inst. of Medical Psychology & Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Carolin Gramsch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Inst. of Medical Psychology & Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Inst. of Medical Psychology & Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| |
Collapse
|
29
|
Van Ryckeghem DM, Crombez G, Van Hulle L, Van Damme S. Attentional bias towards pain-related information diminishes the efficacy of distraction. Pain 2012; 153:2345-2351. [DOI: 10.1016/j.pain.2012.07.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/30/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022]
|
30
|
Schrooten MG, Van Damme S, Crombez G, Peters ML, Vogt J, Vlaeyen JW. Nonpain goal pursuit inhibits attentional bias to pain. Pain 2012; 153:1180-1186. [DOI: 10.1016/j.pain.2012.01.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/14/2012] [Accepted: 01/26/2012] [Indexed: 11/25/2022]
|
31
|
Caes L, Uzieblo K, Crombez G, De Ruddere L, Vervoort T, Goubert L. Negative Emotional Responses Elicited by the Anticipation of Pain in Others: Psychophysiological Evidence. THE JOURNAL OF PAIN 2012; 13:467-76. [DOI: 10.1016/j.jpain.2012.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 02/13/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
|
32
|
Bradshaw DH, Donaldson GW, Jacobson RC, Nakamura Y, Chapman CR. Individual differences in the effects of music engagement on responses to painful stimulation. THE JOURNAL OF PAIN 2011; 12:1262-73. [PMID: 22071366 PMCID: PMC3258530 DOI: 10.1016/j.jpain.2011.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/28/2011] [Accepted: 08/29/2011] [Indexed: 11/23/2022]
Abstract
UNLABELLED Engaged attention, including music listening, has shown mixed results when used as a method for reducing pain. Applying the framework of constructivism, we extend the concept of engagement beyond attention/distraction to include all cognitive and emotional/motivational processes that may be recruited in order to construct an alternative experience to pain and thus reduce pain. Using a music-listening task varying in task demand, we collected stimulus-evoked potentials, pupil dilation, and skin conductance responses to noxious electrocutaneous stimulations as indicators of central and peripheral arousal, respectively. Trait anxiety (Spielberger State-Trait Anxiety Inventory) and absorption (Tellegen Absorption Scale) provided indicators of individual differences. One hundred and fifty-three healthy, normal volunteers participated in a test session in which they received 3 stimulus intensity levels while listening to background tones (No Task) or performing a music-listening task. Linear slopes indicating net engagement (change in stimulus arousal relative to task performance) decreased with increasing task demand and stimulus level for stimulus-evoked potentials. Slopes for pupil dilation response and skin conductance response varied with task demand, anxiety, and absorption, with the largest engagement effect occurring for high anxiety/high absorption participants. Music engagement reduces pain responses, but personality factors like anxiety and absorption modulate the magnitude of effect. PERSPECTIVE Engaging in music listening can reduce responses to pain, depending on the person: people who are anxious and can become absorbed in activities easily may find music listening especially effective for relieving pain. Clinicians should consider patients' personality characteristics when recommending behavioral interventions like music listening for pain relief.
Collapse
Affiliation(s)
- David H Bradshaw
- Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84108, USA.
| | | | | | | | | |
Collapse
|
33
|
Vervoort T, Caes L, Crombez G, Koster E, Van Damme S, Dewitte M, Goubert L. Parental catastrophizing about children’s pain and selective attention to varying levels of facial expression of pain in children: A dot-probe study. Pain 2011; 152:1751-1757. [DOI: 10.1016/j.pain.2011.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 01/10/2023]
|
34
|
Massar SAA, Mol NM, Kenemans JL, Baas JMP. Attentional bias in high- and low-anxious individuals: Evidence for threat-induced effects on engagement and disengagement. Cogn Emot 2011; 25:805-17. [PMID: 21824022 DOI: 10.1080/02699931.2010.515065] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
35
|
Pain-related fear and avoidance of physical exertion following delayed-onset muscle soreness. Pain 2011; 152:1540-1547. [DOI: 10.1016/j.pain.2011.02.038] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/10/2011] [Accepted: 02/16/2011] [Indexed: 11/22/2022]
|
36
|
Notebaert L, Crombez G, Vogt J, De Houwer J, Van Damme S, Theeuwes J. Attempts to control pain prioritize attention towards signals of pain: An experimental study. Pain 2011; 152:1068-1073. [DOI: 10.1016/j.pain.2011.01.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 11/08/2010] [Accepted: 01/14/2011] [Indexed: 12/23/2022]
|
37
|
Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun 2011; 25:386-94. [PMID: 21094682 DOI: 10.1016/j.bbi.2010.11.010] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/22/2010] [Accepted: 11/16/2010] [Indexed: 12/12/2022] Open
Abstract
Chronic abdominal pain is a common symptom of great clinical significance in several areas of medicine. In many cases no organic cause can be established resulting in the classification as functional gastrointestinal disorder. Irritable Bowel Syndrome (IBS) is the most common of these conditions and is considered an important public health problem because it can be disabling and constitutes a major social and economic burden given the lack of effective treatments. IBS aetiology is most likely multi-factorial involving biological, psychological and social factors. Visceral hyperalgesia (or hypersensitivity) and visceral hypervigilance, which could be mediated by peripheral, spinal, and/or central pathways, constitute key concepts in current research on pathophysiological mechanisms of visceral hyperalgesia. The role of central nervous system mechanisms along the "brain-gut axis" is increasingly appreciated, owing to accumulating evidence from brain imaging studies that neural processing of visceral stimuli is altered in IBS together with long-standing knowledge regarding the contribution of stress and negative emotions to symptom frequency and severity. At the same time, there is also growing evidence suggesting that peripheral immune mechanisms and disturbed neuro-immune communication could play a role in the pathophysiology of visceral hyperalgesia. This review presents recent advances in research on the pathophysiology of visceral hyperalgesia in IBS, with a focus on the role of stress and anxiety in central and peripheral response to visceral pain stimuli. Together, these findings support that in addition to lower pain thresholds displayed by a significant proportion of patients, the evaluation of pain appears to be altered in IBS. This may be attributable to affective disturbances, negative emotions in anticipation of or during visceral stimulation, and altered pain-related expectations and learning processes. Disturbed "top-down" emotional and cognitive pain modulation in IBS is reflected by functional and possibly structural brain changes involving prefrontal as well as cingulate regions. At the same time, there is growing evidence linking peripheral and mucosal immune changes and abdominal pain in IBS, supporting disturbed peripheral pain signalling. Findings in post-infectious IBS emphasize the interaction between centrally-mediated psychosocial risk factors and local inflammation in predicting long-term IBS symptoms. Investigating afferent immune-to-brain communication in visceral hyperalgesia as a component of the sickness response constitutes a promising future research goal.
Collapse
|
38
|
Attentional and emotional mechanisms of pain processing and their related factors: a structural equations approach. Pain Res Manag 2010; 15:229-37. [PMID: 20808968 DOI: 10.1155/2010/516176] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND/OBJECTIVE It is known that maladaptive attentional and emotional mechanisms of pain processing - as indicated by constructs such as pain hypervigilance, pain-related anxiety and pain catastrophizing - play an important role in the development and maintenance of chronic pain conditions. However, little is known to date about the potential risk factors for these forms of maladaptive processing. The aim of the present study was to shed more light on this issue. A very comprehensive set of predictor variables was examined in healthy pain-free subjects. METHOD Participants were 92 young and healthy subjects (mean [+/- SD] age 26.99+/-6.90 years; 47 men, 45 women). Maladaptive attentional and emotional mechanisms of pain processing were assessed by self-report measures of pain hypervigilance, pain-related anxiety and pain catastrophizing, as well as by a dot-probe task. The comprehensive set of predictor variables included measures of affective and bodily distress (depression, anxiety and somatization), experimental pain sensitivity, and cortisol reactivity. Directed relationships were estimated by using structural equation modelling. RESULTS Structural equation modelling revealed a significant path from affective and bodily distress to self-reported maladaptive attentional and emotional pain processing. In contrast, the paths from pain sensitivity and cortisol reactivity did not reach the level of significance. CONCLUSION These results support the position that anxiety and depression, as well as somatization, contribute to the aberrance of attentional and emotional mechanisms of pain processing. Surprisingly, the assumption of a close relationship between these maladaptive mechanisms of pain processing and pain sensitivity could not be confirmed.
Collapse
|
39
|
|
40
|
Keeping pain in mind: A motivational account of attention to pain. Neurosci Biobehav Rev 2010; 34:204-13. [DOI: 10.1016/j.neubiorev.2009.01.005] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/08/2009] [Accepted: 01/19/2009] [Indexed: 11/19/2022]
|
41
|
Moore DJ, Keogh E, Eccleston C. Identifying experimental methods to determine the effect of pain on attention: a review of pain, caffeine, alcohol and nicotine studies. Hum Psychopharmacol 2009; 24:601-18. [PMID: 19946936 DOI: 10.1002/hup.1072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To review published studies of the effects that pain and common psychopharmacological substances have on the attentional performance of healthy adults. To identify which attentional tasks have the greatest potential to investigate the effect of pain on attention and provide recommendations for future research. METHODS A search was conducted for reports of experimental studies of attention in the context of pain. This was supplemented with studies on attention and caffeine, nicotine and alcohol. Studies were included if they used a healthy adult sample, used experimental or quasi-experimental methods, were relevant to the study of attention or interruption of pain and/or examined the acute effects of a substance on attention. RESULTS Thirty-two papers, with 49 different experimental studies were identified (12 pain, 21 nicotine, 7 caffeine, 9 alcohol). Fourteen different tasks were reviewed across six domains of attention. The most promising measures of attention were the continuous performance task, flanker task, endogenous pre-cuing task, n-back task, inhibition task and dual task. CONCLUSIONS There are reliable tasks that could be used to determine the effects of pain on attention. Future research is required that develops the utility of these tasks to improve our understanding of the effects pain and analgesia have on attentional performance.
Collapse
Affiliation(s)
- David J Moore
- Centre for Pain Research, The University of Bath, Bath, UK
| | | | | |
Collapse
|
42
|
Nicholas MK. First things first: reductions in catastrophising before fear of movement. Pain 2009; 145:6-7. [PMID: 19520511 DOI: 10.1016/j.pain.2009.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Michael K Nicholas
- Pain Management Research Institute, University of Sydney/Royal North Shore Hospital, Pacific Highway, St. Leonards, NSW 2065, Australia.
| |
Collapse
|
43
|
Glass JM. Review of Cognitive Dysfunction in Fibromyalgia: A Convergence on Working Memory and Attentional Control Impairments. Rheum Dis Clin North Am 2009; 35:299-311. [DOI: 10.1016/j.rdc.2009.06.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Sharpe L, Dear BF, Schrieber L. Attentional Biases in Chronic Pain Associated With Rheumatoid Arthritis: Hypervigilance or Difficulties Disengaging? THE JOURNAL OF PAIN 2009; 10:329-35. [DOI: 10.1016/j.jpain.2008.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 09/05/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
|
45
|
Hay JL, White JM, Bochner F, Somogyi AA, Semple TJ, Rounsefell B. Hyperalgesia in Opioid-Managed Chronic Pain and Opioid-Dependent Patients. THE JOURNAL OF PAIN 2009; 10:316-22. [DOI: 10.1016/j.jpain.2008.10.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 09/15/2008] [Accepted: 10/07/2008] [Indexed: 11/25/2022]
|
46
|
Mather M, Knight M. The emotional harbinger effect: poor context memory for cues that previously predicted something arousing. ACTA ACUST UNITED AC 2009; 8:850-60. [PMID: 19102596 DOI: 10.1037/a0014087] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A key function of memory is to use past experience to predict when something important might happen next. Indeed, cues that previously predicted arousing events (emotional harbingers) garner more attention than other cues. However, the current series of five experiments demonstrates that people have poorer memory for the context of emotional harbinger cues than of neutral harbinger cues. Participants first learned that some harbinger cues (neutral tones or faces) predicted emotionally arousing pictures and others predicted neutral pictures. Then they studied associations between the harbinger cues and new contextual details. They were worse at remembering associations with emotional harbingers than with neutral harbingers. Memory was impaired not only for the association between emotional harbingers and nearby digits, but also for contextual details that overlapped with or were intrinsic to the emotional harbingers. However, new cues that were inherently emotionally arousing did not yield the same memory impairments as the emotional harbingers. Thus, emotional harbinger cues seem to suffer more from proactive interference than do neutral harbinger cues, impairing formation of new associations with cues that previously predicted something arousing.
Collapse
Affiliation(s)
- Mara Mather
- Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, CA 90089-0191, USA.
| | | |
Collapse
|
47
|
Hypervigilance as Predictor of Postoperative Acute Pain: Its Predictive Potency Compared With Experimental Pain Sensitivity, Cortisol Reactivity, and Affective State. Clin J Pain 2009; 25:92-100. [DOI: 10.1097/ajp.0b013e3181850dce] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Rollman GB. Perspectives on hypervigilance. Pain 2009; 141:183-184. [DOI: 10.1016/j.pain.2008.12.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 12/23/2008] [Indexed: 01/08/2023]
|
49
|
Azarpazhooh A, Limeback H, Lawrence HP, Fillery ED. Evaluating the Effect of an Ozone Delivery System on the Reversal of Dentin Hypersensitivity: A Randomized, Double-blinded Clinical Trial. J Endod 2009; 35:1-9. [DOI: 10.1016/j.joen.2008.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 09/26/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
|
50
|
Van Damme S, Crombez G, Spence C. Is visual dominance modulated by the threat value of visual and auditory stimuli? Exp Brain Res 2008; 193:197-204. [DOI: 10.1007/s00221-008-1608-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 10/05/2008] [Indexed: 11/29/2022]
|