Trying to Fix a Painful Problem: The Impact of Pain Control Attempts on the Attentional Prioritization of a Threatened Body Location

  • Wouter Durnez
    Address reprint requests to Wouter Durnez, MSc, Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium.
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
    Search for articles by this author
  • Stefaan Van Damme
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
    Search for articles by this author
Published:November 11, 2014DOI:


      • Pain control attempts may result in heightened attention to pain-related information.
      • Pain control attempts should thus bias attention to the pain-relevant location.
      • A tactile change detection task was presented to pain control and comparison groups.
      • Comparison group shows an attentional bias for the pain location when under threat.
      • Pain control group shows similar attentional bias irrespective of threat.


      Motivational accounts of pain behavior and disability suggest that persisting attempts to avoid or control pain may paradoxically result in heightened attention to pain-related information. We investigated whether attempts to control pain prioritized attention to the location where pain was expected, using a tactile change detection paradigm. Thirty-seven undergraduate students had to detect changes between 2 consecutively presented patterns of tactile stimuli at various body locations. One of the locations was made threatening by occasionally administering a pain-eliciting stimulus. Half of the participants (pain control group) were encouraged to actively avoid the administering of pain by pressing a button as quickly as possible, whereas the other participants (comparison group) were not. The actual amount of painful stimuli was the same in both groups. Results showed that in the comparison group, the anticipation of pain resulted in better detection of tactile changes at the pain location than at the other locations, indicating an attentional bias for the threatened location. Crucially, the pain control group showed a similar attentional bias, but also when there was no actual presence of threat. This suggests that although threat briefly prioritized the threatened location, the goal to control pain did so in a broader, more context-driven manner.


      This study investigates the impact of attempts to control pain on somatosensory processing at the pain location. It provides further insight into the motivational mechanisms of pain-related attention. It also points to the negative consequences of trying to control uncontrollable pain, such as is often the case in chronic pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Baddeley A.D. Working Memory. Clarendon Press, Oxford1986
        • Bolanowski S.J.
        • Gescheider G.A.
        • Fontana A.M.
        • Niemic J.L.
        • Tromblay J.L.
        The effects of heat-induced pain on the detectability, discriminability, and sensation magnitude of vibrotactile stimuli.
        Somatosens Mot Res. 2001; 18: 5-9
        • Chapman C.R.
        Pain: The perception of noxious events.
        in: Sternbach R.A. The Psychology of Pain. Raven Press, New York1987: 169-202
        • Cisler J.M.
        • Koster E.H.W.
        Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review.
        Clin Psychol Rev. 2010; 30: 203-216
        • Crombez G.
        • Eccleston C.
        • De Vlieger P.
        • Van Damme S.
        • De Clercq A.
        Is it better to have controlled and lost than never to have controlled at all? An experimental investigation of control over pain.
        Pain. 2008; 137: 631-639
        • Crombez G.
        • Van Damme S.
        • Eccleston C.
        Hypervigilance to pain: An experimental and clinical analysis.
        Pain. 2005; 116: 4-7
        • De Ruddere L.
        • Goubert L.
        • Prkachin K.M.
        • Stevens M.
        • Van Ryckeghem D.
        • Crombez G.
        When you dislike patients, pain is taken less seriously.
        Pain. 2011; 152: 2342-2347
        • Dowman R.
        • Ben-Avraham D.
        An artificial neural network of orienting attention toward threatening somatosensory stimuli.
        Psychophysiology. 2008; 45: 229-239
        • Eccleston C.
        • Crombez G.
        Pain demands attention: A cognitive-affective model of the interruptive function of pain.
        Psychol Bull. 1999; 125: 356-366
        • Eccleston C.
        • Crombez G.
        Worry and chronic pain: A misdirected problem solving model.
        Pain. 2007; 132: 233-236
        • Eysenck M.W.
        • Derakshan N.
        • Santos R.
        • Calvo M.G.
        Anxiety and cognitive performance: Attentional control theory.
        Emotion. 2007; 7: 336-353
        • Fishbach A.
        • Ferguson M.F.
        The Goal Construct in Social Psychology.
        in: Kruglanski W. Higgins T.E. Social Psychology: Handbook of Basic Principles. Guilford, New York2007: 490-515
        • Folk C.L.
        • Remington R.W.
        Bottom-up priming of top-down attentional control settings.
        Vis Cogn. 2008; 16: 215-231
        • Gallace A.
        • Tan H.Z.
        • Spence C.
        The failure to detect tactile change: A tactile analogue of visual change blindness.
        Psychon Bull Rev. 2006; 13: 300-303
        • Harper D.
        • Hollins M.
        Is touch gating due to sensory or cognitive interference?.
        Pain. 2012; 153: 1082-1090
        • Holm S.
        A simple sequentially rejective multiple test procedure.
        Scand Stat. 1979; 6: 65-70
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms.
        Psychosom Med. 2002; 64: 258-266
        • Legrain V.
        • Damme S.V.
        • Eccleston C.
        • Davis K.D.
        • Seminowicz D.
        • Crombez G.
        A neurocognitive model of attention to pain: Behavioral and neuroimaging evidence.
        Pain. 2009; 144: 230-232
        • Levitt H.
        Transformed up-down methods in psychoacoustics.
        J Acoust Soc Am. 1970; 49: 467-477
        • Moore D.J.
        • Keogh E.
        • Eccleston C.
        The effect of threat on attentional interruption by pain.
        Pain. 2013; 154: 82-88
        • Moseley G.L.
        • Gallace A.
        • Spence C.
        Space-based, but not arm-based, shift in tactile processing in complex regional pain syndrome and its relationship to cooling of the affected limb.
        Brain. 2009; 132: 3142-3151
        • Moseley G.L.
        • Gallagher L.
        • Gallace A.
        Neglect-like tactile dysfunction in chronic back pain.
        Neurology. 2012; 79: 327-332
        • Notebaert L.
        • Crombez G.
        • Vogt J.
        • De Houwer J.
        • Van Damme S.
        • Theeuwes J.
        Attempts to control pain prioritize attention towards signals of pain: An experimental study.
        Pain. 2011; 152: 1068-1073
        • Öhman A.
        • Flykt A.
        • Esteves F.
        Emotion drives attention: Detecting the snake in the grass.
        J Exp Psychol. 2001; 130: 466-478
      2. Pinheiro J.C. Bates D.M. Mixed-Effects Models in S and S-PLUS. Springer-Verlag, New York2000
        • Stevens M.
        • Lammertyn J.
        • Verbruggen F.
        • Vandierendonk A.
        Tscope: A C library for programming cognitive experiments on the MS Windows platform.
        Behav Res Methods. 2006; 38: 280-286
        • Sullivan M.J.L.
        • Bishop S.R.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Van Damme S.
        • Crombez G.
        • Eccleston C.
        • Koster E.H.W.
        Hypervigilance to learned pain signals: A componential analysis.
        J Pain. 2006; 7: 346-357
        • Van Damme S.
        • Crombez G.
        • Eccleston C.
        The anticipation of pain modulates spatial attention: Evidence for pain-specificity in high pain catastrophizers.
        Pain. 2004; 111: 392-399
        • Van Damme S.
        • Legrain V.
        • Vogt J.
        • Crombez G.
        Keeping pain in mind: A motivational account of attention to pain.
        Neurosci Biobehav Rev. 2010; 34: 204-213
        • Van Damme S.
        • Legrain V.
        How efficient is the orienting of spatial attention to pain? An experimental investigation.
        Pain. 2012; 153: 1226-1231
        • Van Hulle L.
        • Van Damme S.
        • Spence C.
        • Crombez G.
        • Gallace A.
        Spatial attention modulates tactile change detection.
        Exp Brain Res. 2013; 224: 295-302
        • Van Ryckeghem D.M.L.
        • Crombez G.
        • Eccleston C.
        • Liefooghe B.
        • Van Damme S.
        The interruptive effect of pain in a multitask environment: An experimental investigation.
        J Pain. 2012; 13: 131-138
        • Vanden Bulcke C.
        • Van Damme S.
        • Durnez W.
        • Crombez G.
        The anticipation of pain at a specific location of the body prioritizes tactile stimuli at that location.
        Pain. 2013; 154: 1464-1468
        • Verbruggen F.
        • Aron A.R.
        • Stevens M.A.
        • Chambers C.D.
        Theta burst stimulation dissociates attention and action updating in human inferior frontal cortex.
        Proc Natl Acad Sci U S A. 2010; 107: 13966-13971
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Weinstein S.
        Intensive and extensive aspects of tactile sensitivity as a function of body part, sex and laterality.
        in: Kenshalo D.R. The Skin Senses. Thomas Springfield, Illinois1968: 195-200