Do patients with chronic pain selectively attend to pain-related information?: preliminary evidence for the mediating role of fear

Abstract

Preliminary evidence from a study using a modified Stroop paradigm suggests that individuals with chronic pain selectively attend to pain-related information. The current study was conducted in an attempt to replicate and extend this finding. Nineteen patients with chronic pain stemming from musculoskeletal injury and 22 healthy control subjects participated. All participants completed a computerised task designed to evaluate attentional allocation to cues thematically related to pain and injury via measurement of detection latencies for dot-probes that followed their presentation. Results indicated that patients did not differ from control subjects in their pattern of responses to dot-probes that were presented following either the pain- or injury-related cues. This pattern of results continued to hold true after including level of depression as a covariate in the analysis. However, when patients were divided on the basis of scores on the Anxiety Sensitivity Index (Peterson, R.A. and Reiss, S., Anxiety Sensitivity Index Manual, 2nd edn., International Diagnostic Systems, Worthington, OH, 1992), a measure related to fear of pain (Asmundson, G.J.G. and Norton, G.R., Behav. Res. Ther., 34 (1996) 545-554), those with low anxiety sensitivity shifted attention away from stimuli related to pain whereas those with high anxiety sensitivity responded similarly to dot-probes regardless of the parameters of presentation. These results suggest that the operation of the information processing system in patients with chronic pain may be dependent on a patient's trait predisposition to fear pain. Theoretical and ecological implications are discussed.

Fear-Avoidance Model of Chronic Pain

“…Asmundson et al 40 44,45 . Also, the "Tampa scale for Kinesiophobia", the standard instrument to assess fear of (re)injury and movement, inadvertedly gave rise to the idea that the FA model is a model of phobia-based psychopathology in which patients hold "irrational and debilitating" beliefs 11 .…”

Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations

“…Depression, pain-related fear, and catastrophizing are associated with increased interference, awareness of pain, and impaired disengagement from pain, and can moderate the effects of attentional coping leading to poor clinical outcomes. 11,19,23,35,47,87,103,123,152,179,195 Similarly, fear of injury or harm has an influence on physical effort and activity. 199 Given such data, it is recommended that psychosocial outcome measures also be administered when assessing physical functioning, as changes, or the lack of changes, in physical functioning following an intervention may be accounted for by existing fear, catastrophizing, and depression.…”

Integration of the avoidance cycle with the schema enmeshment model of pain : relationships with quality of life and disability in chronic, nonmalignant pain.

“…Still other research suggests that anxiety sensitivity plays a crucial role in a person in pain's bias to pain related information, a process crucial in the formation of enmeshment (Asmundson, Kuperos, & Norton, 1997). Based on the findings of the present study combined with previous research, anxiety sensitivity seems to playa moderating role between chronic pain and process variables in the A voidance Cycle such as anxiety, experiential avoidance, and enmeshment which in turn have a more direct effect on functional status.…”

“…The mutual maintenance model (Sharp & Harvey, 2001) argues that anxiety sensitivity is a vulnerability for catastrophizing, placing it in the first stage of the Avoidance Cycle. Asmundson, Kuperos, and Norton (1997) found that anxiety sensitivity had the largest effect on attention bias to pain related information, implying more importance in the Entanglement stage. Still other fear-avoidance based models have shown anxiety sensitivity as having direct and indirect effects on fear of pain and avoidance of pain-related stimuli (Norton & Asmundson, 2003;2004), placing anxiety sensitivity in stages one and three of the Avoidance Cycle, respectively.…”