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Greater Response Interference to Pain Faces Under Low Perceptual Load Conditions in Adolescents With Impairing Pain: A Role for Poor Attention Control Mechanisms in Pain Disability?

Published:October 29, 2018DOI:https://doi.org/10.1016/j.jpain.2018.10.005

      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

        • Becker MW
        Panic search: Fear produces efficient visual search for nonthreatening objects.
        Psychol Sci. 2009; 20: 435-437
        • Bishop SJ
        Trait anxiety and impoverished prefrontal control of attention.
        Nat Neurosci. 2009; 12: 92-98
        • Cohen Kadosh K
        • Heathcote LC
        • Lau JY
        Age-related changes in attentional control across adolescence: How does this impact emotion regulation capacities?.
        Front Psychol. 2014; 5: 111
        • Crombez G
        • Van Ryckeghem DM
        • Eccleston C
        • Van Damme S
        Attentional bias to pain-related information: A meta-analysis.
        Pain. 2013; 154: 497-510
        • Desimone R
        • Duncan J
        Neural mechanisms of selective visual attention.
        Annu Rev Neurosci. 1995; 18: 193-222
        • 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
        Advancing psychological therapies for chronic pain.
        F1000Res. 2017; 6: 461
        • Fisher E
        • Heathcote L
        • Palermo TM
        • de CWAC
        • Lau J
        • Eccleston C
        Systematic review and meta-analysis of psychological therapies for children with chronic pain.
        J Pediatr Psychol. 2014; 39: 763-782
        • Forgeron PA
        • King S
        • Stinson JN
        • McGrath PJ
        • MacDonald AJ
        • Chambers CT
        Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review.
        Pain Res Manag. 2010; 15: 27-41
        • Gagne JR
        • O'Sullivan DL
        • Schmidt NL
        • Spann CA
        • Goldsmith HH
        The shared etiology of attentional control and anxiety: An adolescent twin study.
        J Res Adolesc. 2017; 27: 122-138
        • Haas SA
        • Amso D
        • Fox NA
        The effects of emotion priming on visual search in socially anxious adults.
        Cogn Emot. 2017; 31: 1041-1054
        • Heathcote LC
        • Koopmans M
        • Eccleston C
        • Fox E
        • Jacobs K
        • Wilkinson N
        • Lau JY
        Negative interpretation bias and the experience of pain in adolescents.
        J Pain. 2016; 17: 972-981
        • Heathcote LC
        • Lau JY
        • Mueller SC
        • Eccleston C
        • Fox E
        • Bosmans M
        • Vervoort T
        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
        • Heathcote LC
        • Vervoort T
        • Eccleston C
        • Fox E
        • Jacobs K
        • Van Ryckeghem DM
        • Lau JY
        The relationship between adolescents' pain catastrophizing and attention bias to pain faces is moderated by attention control.
        Pain. 2015; 156: 1334-1341
        • Jensen MP
        • Chen C
        • Brugger AM
        Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain.
        J Pain. 2003; 4: 407-414
        • King S
        • Chambers CT
        • Huguet A
        • MacNevin RC
        • McGrath PJ
        • Parker L
        • MacDonald AJ
        The epidemiology of chronic pain in children and adolescents revisited: A systematic review.
        Pain. 2011; 152: 2729-2738
        • Lau JYF
        • Heathcote LC
        • Beale S
        • Gray S
        • Jacobs K
        • Wilkinson N
        • Crombez G
        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
        • Lavie N
        Perceptual load as a necessary condition for selective attention.
        J Exp Psychol Hum Percept Perform. 1995; 21: 451-468
        • Logan DE
        • Simons LE
        • Stein MJ
        • Chastain L
        School impairment in adolescents with chronic pain.
        J Pain. 2008; 9: 407-416
        • Luna B
        Developmental changes in cognitive control through adolescence.
        Adv Child Dev Behav. 2009; 37: 233-278
        • Mogg K
        • Bradley BP
        Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification.
        Behav Res Ther. 2016; 87: 76-108
        • Mueller SC
        • Hardin MG
        • Mogg K
        • Benson V
        • Bradley BP
        • Reinholdt-Dunne ML
        • Liversedge SP
        • Pine DS
        • Ernst M
        The influence of emotional stimuli on attention orienting and inhibitory control in pediatric anxiety.
        J Child Psychol Psychiatry. 2012; 53: 856-863
        • Raubenheimer J
        An item selection procedure to maximise scale reliability and validity.
        S Afr J Industrial Psychol. 2004; 30: 59-64
        • Schoth DE
        • Nunes VD
        • Liossi C
        Attentional bias towards pain-related information in chronic pain: A meta-analysis of visual-probe investigations.
        Clin Psychol Rev. 2012; 32: 13-25
        • Simon D
        • Craig KD
        • Gosselin F
        • Belin P
        • Rainville P
        Recognition and discrimination of prototypical dynamic expressions of pain and emotions.
        Pain. 2008; 135: 55-64
        • Todd J
        • Sharpe L
        • Johnson A
        • Nicholson Perry K
        • Colagiuri B
        • Dear BF
        Towards a new model of attentional biases in the development, maintenance, and management of pain.
        Pain. 2015; 156: 1589-1600
        • Treisman AM
        • Gelade G
        A feature-integration theory of attention.
        Cogn Psychol. 1980; 12: 97-136
        • Wilson AC
        • Palermo TM
        Physical activity and function in adolescents with chronic pain: A controlled study using actigraphy.
        J Pain. 2012; 13: 121-130