The experimental analysis of the interruptive, interfering, and identity-distorting effects of chronic pain

Abstract

Pain is an unpleasant sensory and emotional experience urging the individual to take action to restore the integrity of the body. The transition from a common episode of acute pain to a state of intermittent or chronic pain has been a constant preoccupation of researchers and clinicians alike. In this review, we approach chronic pain from a modern learning perspective that incorporates cognitive, affective, behavioral and motivational aspects. We view pain as a biologically hard-wired signal of bodily harm that competes with other demands in the person's environment. The basic tenet is that pain urges people to interrupt ongoing activity, elicits protective responses that paradoxically increase interference with daily activities, and compromises the sense of self. Here we briefly summarize existing evidence showing how pain captures attention, and how attention for pain can be controlled.We also consider pain as a strong motivator for learning, and review the recent evidence on the acquisition and generalization of pain-related fear and avoidance behavior, which are likely to interfere with daily life activities. We highlight the paradoxical effects of pain avoidance behavior, and review treatment effects of exposure in vivo. A generally neglected area of research is the detrimental consequences of repeated interference by pain with daily activities on one's sense of "self". We end this review with a plea for the implementation of single-case experimental designs as a means to help customize and develop novel cognitive-behavioral treatments for individuals for chronic pain aimed at reducing the suffering of this large group of individuals.3

Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model

“…They may indeed play distinct roles in modulating responses to acute pain, shaping the transition from acute to chronic pain and the maintenance of pain. Importantly, attentional biases arguably play a role in many if not all of these proposed processes, and could thus be viewed as a fundamental neurocognitive mechanism that is shaped by pain-related learning and memory processes (48,94). This is supported by first evidence that attentional bias to threat signals is still present after extinction (47) and re-emerges during reinstatement (48), consistent with our brain imaging work on the reactivation of previously extinguished responses to conditioned pain and safety cues induced by reinstatement (20,56) or renewal (19).…”

Taking a break in response to pain. An experimental investigation of the effects of interruptions by pain on subsequent activity resumption

“…Future research might address the effects of self-initiated and -paced interruptions or, more generally, the motivational context of interruptions (Vlaeyen et al, 2016).…”

Cognitive biases in pain: an integrated functional–contextual framework

“…In particular, we propose that cognitive biases may have an adaptive value in instances where identification of pain and adoption of protective responses to potentially threatening situations can prevent negative outcomes. 17,84,93 However, when protective responses are unavailable or ineffective, the same cognitive biases may interfere with the pursuit of daily tasks or life goals. Whether cognitive biases to pain-related information are adaptive then depends on their ability to prompt a response that can avert negative pain-related outcomes balanced against the urgency and value of competing goals.…”

“…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.…”

“…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.…”