Attentional, interpretation and memory biases for sensory-pain words in individuals with chronic headache

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.

Cognitive biases in pain: an integrated functional–contextual framework

“…">The presence and impact of cognitive biases in pain: The state of the science.Research on cognitive biases in (chronic) pain has been guided by the research agenda on cognitive biases in psychopathology, where similar theoretical processes are proposed (e.g., 2,24,47 ). As such, paradigms were adapted from psychopathology research (e.g., dot-probe 1,21,37,73 , homograph or homophone task 60,67 , word memory task 36,66,72 ) to investigate cognitive biases for pain-related information. These paradigms typically use symbolic descriptors of health/illness or pain experiences or situations (e.g., words and/or pictures, descriptions of ambiguous situations).…”

“…However, much heterogeneity remains unexplained and available evidence does not show a robust link between cognitive biases for pain-related information and the theorized antecedents and consequences. Notably, research addressing the interaction between cognitive biases is lacking (see 66,69,76 for exceptions). In addition, there is a need for prospective research investigating the link between cognitive biases and the development of chronic pain.…”

Internet-delivered attentional bias modification training (iABMT) for the management of chronic musculoskeletal pain: a protocol for a randomised controlled trial

“…The stimulus pair may be either words or images, although critically includes one threat-related and one neutral stimulus. Stimuli presentation times of 500 and 1250 ms are used as these are the most common stimuli presentation times adopted in chronic pain visual-probe studies (eg, refs 18 20 47) and will allow us to closely compare our results with those of previous research. Immediately following their presentation, the stimuli disappear and a probe appears (either ‘p’ or ‘q’ ) in the location of the neutral stimulus.…”

“…Following this, mean response times will be computed for each participant, with any response >3 SD from their individual mean also removed as outliers. This process ensures extremely quick or slow responses do not unduly bias the results, which are typically removed when cleaning and screening visual-probe data in pain-related research (eg, refs 18 64–67). An attentional bias index will then be computed for each stimulus and presentation time condition using the following equation: (TuPl−TlPl)+(TlPu−TuPu)/2.…”

“…Prevalence estimates of CMSK vary considerably, affecting between 11.4% and 24% of the adult population2 and between 4% and 40% of children and adolescents 3. Negative effects on quality of life are commonly reported in adult4–7 and paediatric8–11 CMSK populations, and theory-driven research12–14 has shown that patients with chronic pain exhibit attentional biases (ie, a selective attention) for salient pain-related words (eg, refs 15–18) and images (eg, refs 19 20) relative to neutral information. Three meta-analyses have supported the presence of attentional biases in patients with chronic pain,21–23 although evidence for the time course of such biases is mixed.…”