Distraction from pain: The role of selective attention and pain catastrophizing.

Katharina M Rischer,Sandra Gigl,Pedro Montoya,Marian Van Der Meulen,Ana M González‐Roldán,Fernand Anton

doi:10.1002/ejp.1634

Abstract

BackgroundPrevious research has demonstrated the efficacy of cognitive engagement in reducing concurrent pain. However, little is known about the role of individual differences in inhibitory control abilities and negative pain‐related cognitions in modulating the magnitude of this type of distraction from pain.MethodsIn a pain distraction paradigm, 41 participants completed a working memory task with both a demanding high load condition (2‐back) and an easy low load condition (0‐back), while receiving warm or painful thermal stimuli to their left forearm. To control for individual differences in sensitivity to pain and perceived task difficulty, nociceptive stimulus intensity and task speed were individually calibrated. Additionally, participants completed a set of cognitive inhibition tasks (flanker, go/nogo, Stroop) and questionnaires about negative pain‐related cognitions (fear of pain, pain catastrophizing) prior to the distraction paradigm.ResultsAs expected, engaging in the high load condition significantly reduced perceived intensity and unpleasantness of nociceptive stimuli, compared to the low load condition. The size of the distraction effect correlated significantly with better cognitive inhibition and selective attention abilities, as measured by the flanker task. A moderation analysis revealed a significant interaction between pain catastrophizing and performance in the flanker task in predicting the distraction effect size: Participants who performed well on the flanker task showed more pain reduction, but only when they were average to high pain catastrophizers.ConclusionsSelective attention abilities and pain catastrophizing seem to be important factors in explaining individual differences in the size of the analgesic response to a distractive task.SignificanceUnderstanding which factors influence the effectiveness of cognitive engagement in distracting from pain could help to optimize its therapeutic application in patient care. This study shows that a complex interplay of cognitive inhibition abilities, specifically selective attention, and negative pain‐related cognitions, such as pain catastrophizing, modulate the magnitude of the distraction effect.

Highlights

Distraction through cognitive engagement is a commonly used form of pain inhibition (McCaul & Malott, 1984), yet the reported magnitude of the analgesic response varies between studies (Verhoeven, Van Damme, Eccleston, Van Ryckeghem, Legrain & Crombez, 2011), with some studies finding large effects (Buhle, Stevens, Friedman, & Wager, 2012; Buhle & Wager, 2010) and other studies reporting smaller (McCaul, Monson, & Maki, 1992) or no effects (Goubert, Crombez, Eccleston, & Devulder, 2004)
Other factors that have been shown to influence the effectiveness of task-related analgesia are negative pain-related cognitions, such as pain catastrophizing and fear of pain, probably by promoting hypervigilance to pain (Van Damme, Crombez, Eccleston, & Roelofs, 2004)
While some studies have associated pain catastrophizing with a reduced distraction effect (Heyneman, Fremouw, Gano, Kirkland, & Heiden, 1990; Prins, Decuypere, & Van Damme, 2014; Verhoeven, Goubert, Jaaniste, Van Ryckeghem, & Crombez, 2012), other studies found either no such modulation (Van Damme, Crombez, Van De Wever, & Goubert, 2008; Van Ryckeghem, Crombez, Van Hulle, & Van Damme, 2012), reported that the effects of pain catastrophizing may diminish over time (Campbell et al, 2010) or depend on the participants’ motivation (Verhoeven et al, 2010)

Summary

| INTRODUCTION

Distraction through cognitive engagement is a commonly used form of pain inhibition (McCaul & Malott, 1984), yet the reported magnitude of the analgesic response varies between studies (Verhoeven, Van Damme, Eccleston, Van Ryckeghem, Legrain & Crombez, 2011), with some studies finding large effects (Buhle, Stevens, Friedman, & Wager, 2012; Buhle & Wager, 2010) and other studies reporting smaller (McCaul, Monson, & Maki, 1992) or no effects (Goubert, Crombez, Eccleston, & Devulder, 2004). Ethical approval was obtained from the Ethics Review Panel of the University of Luxembourg

| Procedure

Findings

| DISCUSSION