Cognitive biases in pain: an integrated functional–contextual framework

Abstract

Cognitive biases in the context of pain.Contemporary models explaining the exacerbation and maintenance of pain, disability and distress, assign a pivotal role to cognitive biases. These models assume that cognitive biases are maladaptive, trait-like processes, and propose that individuals who selectively attend to pain-related information (attention bias), interpret ambiguous pain and/or health relevant information as threatening (interpretation bias), and/or recall pain-related information selectively or as more negative/threatening than initially experienced (memory bias), report higher levels of pain and disability and are at increased risk for developing chronic pain. 10,11,15,16,51,56,77,87,93,94 This intuitively appealing idea has resulted in an exponential increase in research addressing the presence, antecedents, and consequences of cognitive biases in people experiencing acute and chronic pain. 10,13,17,41,51,52,67,68,78 However, results are inconsistent and puzzling, with mixed support for theoretical-driven assumptions. 12,41,67,87,88,93 The aim of this review is to (a) synthesize and discuss current knowledge on the role of cognitive biases in pain, (b) provide conceptual and methodological explanations for equivocal findings, and (c) develop an integrated functional-contextual framework for understanding the role of cognitive biases in pain. Based on this framework, we propose a new research agenda and discuss implications for clinical practice. 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). Recently, a number of comprehensive reviews synthesized available evidence following this research tradition. 13,52,67,68,78 For attention bias, these reviews revealed small effects, indicating that people experiencing acute or chronic pain show a bias towards pain-related information, particularly sensory pain words. 13,78 No bias was found in people without or merely anticipating pain. 68,78 Most remarkably, no consistent relationship

When “a headache is not just a headache”: A qualitative examination of parent and child experiences of pain after childhood cancer

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“…Therefore, they may not react sensitively to pain stimuli and interpret pain stimuli as threatening in the same manner as chronic pain patients with musculoskeletal disorders. So, for those individuals, interpreting ambiguous bodily sensations as threatening and catastrophizing during the early stage of attention can determine attentional engagement to those stimuli during the later stage of attention (Van Ryckeghem et al, 2019). Future studies need to compare attentional and interpretational biases between chronic pain patients with different types of chronic pain conditions (e.g., musculoskeletal disorders vs. autoimmune diseases) and compare attentional biases toward different types of stimuli including ambiguous sensorimotor stimuli, pictures of body part relevant to the pain location as well as symbolic pain stimuli.…”

MINDflex Training for Cognitive Flexibility in Chronic Pain: A Randomized, Controlled Cross-Over Trial

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