Catastrophizing delays the analgesic effect of distraction

Abstract

Behavioral analgesic techniques such as distraction reduce pain in both clinical and experimental settings. Individuals differ in the magnitude of distraction-induced analgesia, and additional study is needed to identify the factors that influence the pain relieving effects of distraction. Catastrophizing, a set of negative emotional and cognitive processes, is widely recognized to be associated with increased reports of pain. We sought to evaluate the relationship between catastrophizing and distraction analgesia. Healthy participants completed three sessions in a randomized order. In one session (Pain Alone), pain was induced by topical application of a 10% capsaicin cream and simultaneous administration of a tonic heat stimulus. In another session (Pain + Distraction), identical capsaicin+heat application procedures were followed, but subjects played video games that required a high level of attention. During both sessions, verbal ratings of pain were obtained and participants rated their degree of catastrophizing. During the other session (Distraction Alone) subjects played the video games in the absence of any pain stimulus. Pain was rated significantly lower during the distraction session compared to the "pain alone" session. In addition, high catastrophizers rated pain significantly higher regardless of whether the subjects were distracted. Catastrophizing did not influence the overall degree of distraction analgesia; however, early in the session high catastrophizers had little distraction analgesia, though later in the session low and high catastrophizers rated pain similarly. These results suggest that both distraction and catastrophizing have substantial effects on experimental pain in normal subjects and these variables interact as a function of time.

Differences in Pain Coping Between Black and White Americans: A Meta-Analysis

“…Some results suggest that diverting and reinterpreting strategies confer benefit, particularly in the short term, by distracting individuals from painful sensations [4;45;54;83], whereas other studies suggest these strategies are associated with increased pain and dysfunction [53;52;75]. These inconsistent findings suggest that the effectiveness of attentional diversion strategies is moderated by other factors such as whether the individual has a clinical pain condition or is otherwise pain-free [83], the duration of pain [62;68;88], and the level of pain catastrophizing [78;13]. In the context of chronic pain in particular, these latter results are consistent with conceptualizing attentional diversion strategies as avoidance techniques that may develop from a fear of pain.…”

Individual Differences in the Effects of Music Engagement on Responses to Painful Stimulation

“…4, 7, 40 Studies have shown that catastrophizing contributes to failure to disengage attention from pain cues. 34, 39 Brain imaging research confirms these findings, showing that anxiety biases attentional networks (e.g., amygdala-prefrontal circuits) towards activation of threat-related representations and contributes to under-activation of alternative non-threat-related representations.…”

Examining Affective-Motivational Dynamics and Behavioral Implications Within The Interpersonal Context of Pain

“…Specifically, high catastrophizing individuals appraise pain as signalling physical harm, leading to prioritization of pain control goals (i.e., to escape from or control pain) and associated negative emotional responses (i.e., fear). There is evidence that high catastrophizing individuals tend to show attentional hypervigilance to pain sensations (generally thought to exacerbate negative emotion and pain outcomes) and find less benefit from distraction as an emotion regulatory strategy [e.g., 10,33] unless the salience of competing goals (e.g., working towards a reward in spite of pain) is enhanced [see e.g., 86]. These findings suggest that differential prioritization of goals (and associated emotional states) may inform the utility of a given emotion regulatory strategy and -as individuals hold multiple goals simultaneously --highlight the possible malleability of goal context.…”