Search

Contemporary pain models highlight cognitive-processing biases (i.e., attention (AB), interpretation (IB), and memory bias (MB)) as key processes that contribute to poor pain outcomes. However, existing research has yielded inconsistent findings regarding the presence and impact of these biases on pain outcomes. Recognizing the need to explore these biases simultaneously, contemporary pain models suggest that cognitive biases (CBs) are interrelated, and may have a combined impact upon pain problems. The current study aims to investigate the interrelationships between cognitive biases using the PainAIM paradigm, a novel approach enabling simultaneous evaluation of pain-related AB, IB, and MB using cues signaling actual pain rather than symbolic information. We hypothesized the presence and positive associations of biases for pain-related cues and the predictive value of combined AB and IB for poor pain outcomes. Eighty-four healthy participants completed the PainAIM paradigm, followed by a cold pressor task probing pain experience and pain-related task interference. Results indicated an inverse relationship between AB and IB for ambiguous pain cues. In addition, there was a positive association between participants’ AB for ambiguous pain and their MB for the same cues. Contrary to our hypotheses, CB indices did not predict experimental pain outcomes. These findings provide support for the interrelationships between pain-related CBs. However, future research on the temporal order of CBs and their combined impact on pain outcomes is needed. By overcoming limitations associated with traditional paradigms, the PainAIM paradigm offers a promising research tool for the further study of combined CBs in the context of pain.

The present study examined the role of personal relevance of sensory pain-related words in selective attentional processing measured with a modified Stroop task administered to 30 patients with chronic low back pain. A related aim of this study was to introduce the application of multilevel analysis to test the influence of personal relevance on selective attentional processing in this sample. Patients completed the modified Stroop task, as well as a set of self-report measures aimed to assess Fear of Pain, Trait Anxiety, Catastrophizing, Pain Vigilance, and Pain Intensity. The modified Stroop task comprised 33 sensory pain-related words for which the personal relevance towards current concerns was rated afterwards by each participant on a 7-point Likert-type scale. The multilevel analyses did not support the hypothesis that personal relevance of sensory pain-related words interacted with Fear of Pain scores of patients in accounting for reaction times in naming the color of sensory pain-related words. None of the other self-report measures accounted for reaction times in isolation or in interaction with personal relevance. The modified Stroop task does not appear to be a robust measure of selective attentional processing in patients with chronic low back pain. The usefulness of other paradigms, such as the visual dotprobe task, should be explored in examining selective attentional processing in this population.

Objectives. The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life.

The present study attempted to replicate the robustness of a two-factor model of the Tampa Scale for Kinesiophobia (TSK) in chronic low back pain (CLBP) patients and fibromyalgia patients, by means of confirmatory factor analysis. Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two-factor model fitted best in both pain samples. These two factors were labelled somatic focus, which reflects the belief in underlying and serious medical problems, and activity avoidance, which reflects the belief that activity may result in (re)injury or increased pain. Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients. Implications of the results are discussed and directions for future research are provided.

The present study assessed, by means of a modified Stroop paradigm, whether highly fearful patients with chronic low back pain pay selective attention to words related to movement and injury. Two groups of patients (High Fear and Low Fear) were included based on their scores on the Tampa Scale of Kinesiophobia (TSK), a measure of fear of movement or (re)injury. A control group was recruited by means of advertisement in a local newspaper. Repeated-measures analysis of variance was conducted to examine whether highly fearful pain patients pay more selective attention to movement and injury words, compared to patients with low pain-related fear and controls. The results from the present study do not support the proposition that highly fearful patients with chronic low back pain selectively pay attention to words related to injury and movement. Limitations of the modified Stroop paradigm are discussed as well as the need for the application of alternative methods such as the dot-probe paradigm.

The aim of this study was to investigate whether pain itself or pain-related fear is crucial in eliciting attentional bias towards pain-related information in healthy individuals. The results from two successive experiments provide evidence that attentional bias does not take place as a function of pain-related fear or as a function of pain per se. Attentional bias for pain words was neither found to be related to trait variables like anxiety, depression, catastrophising, fear of pain, and pain vigilance. Implications of the results are discussed and directions for future research are provided.

Although the modified Stroop paradigm is considered to be a prominent paradigm for investigating selective attention in emotional disorders, relatively few studies have applied this paradigm to examine selective attention in chronic pain patients. Moreover, the results from these studies are not robust. The purpose of this article is to review the evidence for attentional bias in chronic pain patients, by means of a meta-analysis. Data from five studies were pooled and summarized into a mean difference (MD). Significant MD estimations (in milliseconds) were found for both sensory pain words (MD=26.7; 95% confidence interval (CI) 10.0–42.9) and affective pain words (MD=28.1; 95% CI 0.4–55.8). Meta-regression analysis indicated that methodological quality did not significantly affect the pooled MD estimation for both sensory pain words and affective pain words. Thus, the results from the present meta-analysis on studies applying the modified Stroop paradigm suggest that chronic pain patients selectively attend to both pain sensory and pain affective stimuli. Furthermore, the MD estimation did not depend on the methodological quality, tentatively indicating that even though studies differed in methodology, the results were rather consistent. Implications of the results are discussed. Copyright 2002 European Federation of chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.

In this study an experiment was conducted to examine whether failure experiences have an effect on pain report, pain tolerance and pain avoidance. Furthermore, it was investigated if negative affectivity (NA) affected the impact of failure feedback on pain report, either as a mediator, in the case of negative state affect, or as a moderator when NA as a personality trait was considered. Fifty-four healthy female volunteers were included and randomly assigned to one of three conditions: (1) failure feedback; (2) success feedback; (3) neutral control task. After the manipulation, subjects were given a cold pressor task in order to obtain pain measures. Regarding the effects of failure feedback on pain report, it was found that, in comparison with success feedback, failure feedback led to increased pain report. With regard to pain tolerance, pain was tolerated for longer when preceded by success feedback than when preceded by failure feedback. Differences between failure and control conditions did not reach significance. With regard to pain avoidance, no differences between the conditions were found. The hypothesized mediating role of negative state affect was not found. Though in the hypothesized direction, no significant effect was found for NA-trait moderating the influence of failure on pain. The discussion focuses on a number of research questions that remain to be answered, and the clinical relevance of the effects of failure and success experiences on pain report and pain tolerance.

Computerized diary measurement of pain, disability and psychological adaptation was performed four times a day for 4 weeks in 80 patients with various duration of unexplained pain. Reported are (1) the temporal characteristics and stability of pain report during the 4-week measurement period, (2) the association between pain duration and pain report, disability and general psychopathology, and (3) the accordance between diary assessment versus questionnaire assessment of pain, disability and psychological adaptation. No evidence of instrument reactivity was found: pain report was stable across the 4-week period. However, pain report appeared to be highly variable both between and within days. About half the patients showed a clear increasing trend in pain during the day. Several differences were found between subgroups of patients varying in pain duration. Patients with less than 6 months of pain reported significantly less pain intensity, disability and fatigue than patients whose pain persisted for more than 6 months. Pain coping and responses to pain behaviors by the spouse also differed for the subgroups: longer pain duration was associated with increased catastrophizing and solicitous responses from the spouse. Comparison of scores obtained with diary versus questionnaire assessment indicated moderate correlations for most variables. Retrospective (questionnaire) assessment of pain intensity yielded significantly higher pain scores than diary assessment.

Dissociative identity disorder (DID; called multiple personality disorder in DSMIII-R) is a psychiatric condition in which two or more identity states recurrently take control of the person's behavior. A characteristic feature of DID is the occurrence of apparently severe amnestic symptoms. This paper is concerned with experimental research of memory function in DID and focuses on between-identity transfer of newly learned neutral material. Previous studies on this subject are reviewed and a pilot study with four subjects is described. This study is specifically concerned with the question whether self-reported asymmetries in between-identity transfer can be replicated on experimental memory tests. A secondary aim was to examine whether, in the absence of explicit transfer, implicit transfer of information would occur. The results showed that the apparent amnestic asymmetry for explicit information was substantiated in the laboratory, although at least some leakage was present between the apparently amnestic identities. No evidence was found for better performance on implicit than on explicit memory tests in the apparently amnestic identities. In the discussion, parallels between apparent amnesia in DID and state-dependent memory are drawn, and the question of simulated amnesia is addressed.