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Cognitive Biases in Children and Adolescents With Chronic Pain: A Review of Findings and a Call for Developmental Research

  • Jennifer Y.F. Lau
    Correspondence
    Address reprint requests to Jennifer Y.F. Lau, PhD, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
    Affiliations
    Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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  • Lauren C. Heathcote
    Affiliations
    Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California
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  • Sarah Beale
    Affiliations
    Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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  • Suzy Gray
    Affiliations
    Paediatric Rheumatology and Chronic Pain Service, Evelina London Children's Hospital, Guys and St. Thomas's Foundation Trust, London, United Kingdom
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  • Konrad Jacobs
    Affiliations
    Oxford Centre for Children and Young People in Pain (OXCYPP) and Department of Children's Psychological Medicine, Oxford University Hospitals, Oxford, United Kingdom
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  • Nick Wilkinson
    Affiliations
    Paediatric Rheumatology and Chronic Pain Service, Evelina London Children's Hospital, Guys and St. Thomas's Foundation Trust, London, United Kingdom
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  • Geert Crombez
    Affiliations
    Department of Experimental-Clinical and Health Psychology, Ghent Health Psychology Lab, Ghent University, Ghent, Belgium

    Centre for Pain Research, University of Bath, Bath, United Kingdom
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Published:February 04, 2018DOI:https://doi.org/10.1016/j.jpain.2018.01.005

      Abstract

      Cognitive biases that emphasize bodily harm, injury, and illness could play a role in the maintenance of chronic pain by facilitating fear and avoidance. Whereas extensive research has established attention, interpretation, and memory biases in adults with chronic pain, far less is known about these same biases in children and adolescents with pain. Studying cognitive biases in attention, interpretation, and memory in relation to pain occurring in youth is important because youth is a time when pain can first become chronic, and when relationships between cognitive biases and pain outcomes emerge and stabilize. Thus, youth potentially offers a time window for the prevention of chronic pain problems. In this article, we summarize the growing corpus of data that have measured cognitive biases in relation to pediatric pain. We conclude that although biases in attention, interpretation, and memory characterize children and adolescents with varying pain experiences, questions regarding the direction, magnitude, nature, and role of these biases remain. We call for independent extension of cognitive bias research in children and adolescents, using well powered longitudinal studies with wide age ranges and psychometrically sound experimental measures to clarify these findings and any developmental trends in the links between cognitive biases and pain outcomes.

      Perspective

      This article provides a rationale for the theoretical and practical importance of studying the role of cognitive biases in children and adolescents with chronic pain, which has to date, been relatively understudied. Existing findings are reviewed critically, and recommendations for future research are offered.

      Key words

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