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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Article info
Publication history
Published online: May 04, 2018
Accepted:
April 18,
2018
Received in revised form:
March 15,
2018
Received:
November 7,
2017
Footnotes
The authors have no conflicts of interest to declare.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of the American Pain Society
