Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth before and after performance evaluation

Abstract

This study investigated attentional biases for pain and social threat versus neutral stimuli in 54 youth with functional abdominal pain (FAP) and 53 healthy control subjects (ages 10 to 16 years). We assessed attentional bias using a visual probe detection task (PDT) that presented pain and social threat words in comparison to neutral words at conscious (1250 ms) and preconscious (20 ms) presentation rates. We administered the PDT before and after random assignment of participants to a laboratory stressor—failure versus success feedback regarding their performance on a challenging computer game. All analyses controlled for trait anxiety. At the conscious rate of stimulus presentation, FAP patients exhibited preferential attention toward pain compared with neutral stimuli and compared with the control group. FAP patients maintained preferential attention toward conscious pain stimuli after performance feedback in both failure and success conditions. At the preconscious rate of stimulus presentation, FAP patients’ attention was neutral at baseline but increased significantly toward pain stimuli after performance feedback in both failure and success conditions. FAP patients’ somatic symptoms increased in both failure and success conditions; control youth’s somatic symptoms only increased after failure. Regarding social threat, neither FAP nor control youth exhibited attentional bias toward social threat compared with neutral stimuli at baseline, but both FAP and control youth in the failure condition significantly increased attention away from social threat after failure feedback. Results suggest that FAP patients preferentially attend to pain stimuli in conscious awareness. Moreover, performance evaluation may activate their preconscious attention to pain stimuli.

Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample

“…The highest risk for later distress disorders occurred among children whose somatic symptoms persisted across several developmental periods. Chronic pain may extract cumulative psychosocial consequences that increase risk for later emotional distress (Walker et al , 2002): decreased academic achievement; restriction of mental health-enhancing activities (e.g., exercise); maladaptive interoception (Hyams & Hyman, 1998), including increased attentional bias to/perception of pain (Dimsdale & Dantzer, 2007, Beck et al , 2011); and periods of irritability and social withdrawal.…”

Children’s selective attention to pain and avoidance behaviour: The role of child and parental catastrophizing about pain

“…Selective attention toward pain (words) was observed among children with functional abdominal pain [5], but the reverse pattern (attentional avoidance) was observed among children with recurrent abdominal pain [9].…”

Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

“…[33][34][35][36] Anxiety can alter pain sensitivity by increasing vigilance to potential threat, influencing pain coping, 37 and disrupting endogenous opioid pain-control systems. 37 Selective attention to pain-related information [38][39][40][41] and a low threshold for alarm 42 may lead patients with FAP to attend to minor discomfort and withdraw from activities, thereby potentially exacerbating their emotional distress. Abdominal pain also may legitimize children' s absence from school and other activities 43 ; parents may try to protect their child with FAP from settings associated with pain.…”