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

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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.