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Attentional and Interpretational Biases Toward Pain-Related Stimuli in Children and Adolescents: ASystematic Review of the Evidence

  • Melanie Brookes
    Affiliations
    Department of Psychology, University of Sydney, Australia.
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  • Louise Sharpe
    Correspondence
    Address reprint requests to Louise Sharpe, University of Sydney, Departmentof Psychology, Brennan MacCallum Building A17, Manning Road, Sydney, NSW 2006, Australia.
    Affiliations
    Department of Psychology, University of Sydney, Australia.
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  • Kasia Kozlowska
    Affiliations
    Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.

    Disciplines of Psychiatry (Kozlowska, Brown, McLean) and of Paediatrics and Child Health, University of Sydney Medical School, Sydney, New South Wales, Australia.

    Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School, Sydney, New South Wales, Australia.
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      Highlights

      • There are few studies of cognitive biases and pain in children and adolescents.
      • Evidence for vigilance to pain-related stimuli in youth with chronic pain.
      • No convincing evidence of biases in other attentional processes exists.
      • Youth with chronic pain seem to interpret ambiguous stimuli as pain related.

      Abstract

      This review investigated whether youth exhibit attention or interpretation biases toward pain-related information and whether such biases are more pronounced in youth with chronic pain. Three databases were searched to identify studies that assessed attention or interpretation biases using an accepted experimental paradigm. Ten studies were identified, 8 examining attentional biases and 2 examining interpretation biases. As in the adult literature, there was no evidence of attentional biases toward pain in youth without chronic pain. Three studies investigating youth without chronic pain found evidence for relationships between catastrophizing or anxiety and indicators of vigilance or avoidance (in 2 cases, for youth with low self-reported attentional control). For attentional biases, 5 studies compared youth with and without chronic pain. Two of these studies measured cortical correlates and found evidence of neurologic activity indicating a bias in orienting to pain-related stimuli. Three studies examined biases toward pain-related words or pictures. Of those, 2 found evidence of biases at subliminal presentation times, indicating vigilance (although 1 only after a stressful task). For supraliminal presentations, 1 study found evidence of avoidance, one of difficulty disengaging, and one of general slowing of responses. Only 1 study compared youth with and without pain for interpretation bias in adolescents, and interpretation biases were greater for youth with chronic pain. As with attention, no evidence for interpretation biases were found in youth without chronic pain. Overall, there is weak evidence to support vigilance in youth with chronic pain compared with those without. However, whether pain affects the subsequent deployment of attention is unclear. There is no evidence for biases toward pain in youth without chronic pain, but evidence suggests that anxiety or catastrophizing and attentional control may moderate pain-related attentional biases. There is also weak evidence of interpretation bias in youth with chronic pain compared with those without.

      Perspective

      Children without chronic pain do not show interpretation or attention biases toward pain-related stimuli. However, there is weak evidence for the presence of attention biases, characterized by vigilance toward pain-related stimuli and pain-related interpretation bias in children with chronic pain compared with those without.

      Key words

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