Abstract
Persistent pain in young people in the community is common, but individuals vary in
how much pain impacts daily life. Information-processing accounts of chronic pain
partly attribute the fear and avoidance of pain, as well as associated interference,
to a set of involuntary biases, including the preferential allocation of attention
resources toward potential threats. Far less research has focused on the role of voluntary
goal-directed attention control processes, the ability to flexibly direct attention
toward and away from threats, in explaining pain-associated interference. Using a
visual search task, we explored a poor attention control account of pain interference
in young people with persistent pain from the community. One hundred and forty five
young people aged 16 to 19 years were categorized into three groups: non-chronic pain
(n = 68), low-interfering persistent pain (n = 40), and moderate- to high-interfering
persistent pain (n = 22). We found that only adolescents with moderate-to high-interfering
persistent pain but not the other two groups of adolescents were affected by a search
task preceded by a pain face (compared to a neutral face), but this within-group difference
emerged only under low perceptual load conditions. Because low perceptual load conditions
are thought to require more strategic attention resources to suppress the interfering
effects of pain face primes, our findings are consistent with a poor attention control
account of pain interference in young people. Analyses further showed that these differences
in task performance were not explained by confounding effects of anxiety. If replicated,
these findings may have implications for understanding and managing the pain-associated
disability in adolescents with chronic pain.
Perspective
Young people with moderately and highly interfering pain responded slower on an easy
search task after seeing a pain face than after seeing a neutral face. If replicated,
these findings could mean that boosting the ability to control attention toward and
away from threatening cues is an effective strategy for managing interference from
pain.
Key words
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References
- Panic search: Fear produces efficient visual search for nonthreatening objects.Psychol Sci. 2009; 20: 435-437
- Trait anxiety and impoverished prefrontal control of attention.Nat Neurosci. 2009; 12: 92-98
- Age-related changes in attentional control across adolescence: How does this impact emotion regulation capacities?.Front Psychol. 2014; 5: 111
- Attentional bias to pain-related information: A meta-analysis.Pain. 2013; 154: 497-510
- Neural mechanisms of selective visual attention.Annu Rev Neurosci. 1995; 18: 193-222
- Pain demands attention: A cognitive-affective model of the interruptive function of pain.Psychol Bull. 1999; 125: 356-366
- Advancing psychological therapies for chronic pain.F1000Res. 2017; 6: 461
- Systematic review and meta-analysis of psychological therapies for children with chronic pain.J Pediatr Psychol. 2014; 39: 763-782
- Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review.Pain Res Manag. 2010; 15: 27-41
- The shared etiology of attentional control and anxiety: An adolescent twin study.J Res Adolesc. 2017; 27: 122-138
- The effects of emotion priming on visual search in socially anxious adults.Cogn Emot. 2017; 31: 1041-1054
- Negative interpretation bias and the experience of pain in adolescents.J Pain. 2016; 17: 972-981
- Child attention to pain and pain tolerance are dependent upon anxiety and attention control: An eye-tracking study.Eur J Pain. 2017; 21: 250-263
- The relationship between adolescents' pain catastrophizing and attention bias to pain faces is moderated by attention control.Pain. 2015; 156: 1334-1341
- Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain.J Pain. 2003; 4: 407-414
- The epidemiology of chronic pain in children and adolescents revisited: A systematic review.Pain. 2011; 152: 2729-2738
- Cognitive biases in children and adolescents with chronic pain: A review of findings and a call for developmental research.J Pain. 2018; 19: 589-598
- Perceptual load as a necessary condition for selective attention.J Exp Psychol Hum Percept Perform. 1995; 21: 451-468
- School impairment in adolescents with chronic pain.J Pain. 2008; 9: 407-416
- Developmental changes in cognitive control through adolescence.Adv Child Dev Behav. 2009; 37: 233-278
- Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification.Behav Res Ther. 2016; 87: 76-108
- The influence of emotional stimuli on attention orienting and inhibitory control in pediatric anxiety.J Child Psychol Psychiatry. 2012; 53: 856-863
- An item selection procedure to maximise scale reliability and validity.S Afr J Industrial Psychol. 2004; 30: 59-64
- Attentional bias towards pain-related information in chronic pain: A meta-analysis of visual-probe investigations.Clin Psychol Rev. 2012; 32: 13-25
- Recognition and discrimination of prototypical dynamic expressions of pain and emotions.Pain. 2008; 135: 55-64
- Towards a new model of attentional biases in the development, maintenance, and management of pain.Pain. 2015; 156: 1589-1600
- A feature-integration theory of attention.Cogn Psychol. 1980; 12: 97-136
- Physical activity and function in adolescents with chronic pain: A controlled study using actigraphy.J Pain. 2012; 13: 121-130
Article info
Publication history
Published online: October 29, 2018
Accepted:
October 15,
2018
Received in revised form:
September 29,
2018
Received:
May 1,
2018
Footnotes
Supported by internal funding from the King's College London Biomedical Research Centre to Jennifer Y.F. Lau.
The authors have no conflicts of interest to declare.
Identification
Copyright
© Published by Elsevier Inc. on behalf of the American Pain Society
