Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations.
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504 citations
Cites background from "Attentional bias towards pain-relat..."
...High levels of depression, distress, and catastrophizing, and low levels of self-efficacy for managing pain may produce attentional and information-processing biases that lead individuals to attend selectively and intensely to pain-related stimuli.(48,188,201,234) Catastrophizers experience more difficulty controlling or suppressing pain-related thoughts than do noncatastrophizers, they ruminate more about their pain sensations, and their cognitive and physical task performance is more disrupted by anticipation of pain....
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262 citations
Cites background or result from "Attentional bias towards pain-relat..."
...(2012), who only included studies in which both a chronic pain group and a control group were present [135]....
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...These results extend the meta-analysis of Schoth and colleagues (2012), which did not address the issue of stimulus material, but are in line with the results of an early meta-analysis including only modified Stroop tasks [129,135]....
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...This conclusion is at odds with previous meta-analyses on this topic [129,135]....
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...This idea has been variably discussed as somatosensory amplification [12,98], hypervigilance [23,35] and, more recently, as attentional bias [81,119,129,135]....
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...Reviews on this topic have been reported, but are early reviews [119,129] or are narrowly focused [129,135]....
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243 citations
196 citations
References
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"Attentional bias towards pain-relat..." refers background in this paper
..., 2007), the latter has been associated with hypervigilance for threat (Beck et al., 1985). Patients with chronic pain may therefore be particularly vulnerable to ruminating or worrying over pain-related information. Research has found worry and rumination to be common in patients with chronic pain, which does not arise from general psychopathology (De Vlieger, Crombez, & Eccleston, 2006; Eccleston, Crombez, Aldrich, & Stannard, 2001). The results of the current meta-analysis are supportive of such processes of rumination, as shown via pronounced biases during longer stimuli presentation times. Furthermore, theMisdirected Problem-SolvingModel (Eccleston & Crombez, 2007) proposes worry to result in hypervigilance for pain and pain information. This remains to be specifically tested, but is suggestive that biases at shorter presentation times may also be driven by this variable. Alternatively, biases at this shorter stage may arise due to different factors. For example, numerous triggers of pain exist, which is particularly true for chronic headache (Martin & MacLeod, 2009). Patients with pain may therefore scan their environment for relevant trigger information in an attempt to avoid them. Kelman (2007) has argued avoidance of all triggers to be both unrealistic and stressinducing, the latter of which is itself a very commonly reported trigger in headache. Once again, the notion that attentional bias may be implicated in the causation and maintenance of pain is highlighted. It is important for future research to fully explore this possibility, along with the role worry, rumination and trigger avoidance play in attentional bias. The presence of attentional bias in chronic pain may have a range of implications for the patient. Pain itself demands attentional resources (Eccleston & Crombez, 1999), which humans possess in limited quantities. As a result, detrimental effects have been commonly found in attention-demanding tasks (e.g. Kuhajda, Thorn, Klinger, & Rubin, 2002; Veldhuijzen et al., 2006). As attentional bias also demands a portion of an individual's cognitive resources, even greater load is placed upon the patient. Patients who demonstrate attentional bias may therefore be particularly vulnerable to experiencing detrimental effects in general cognitive performance. The implications of such effects upon everyday functioning could be wide-ranging, including negative impacts upon employment, academic performance, and outcomes of psychological interventions to provide a few examples. Furthermore, bias may also be indicative of patient coping. Investigating recall bias in 63 patients with lower back pain, Pincus and Newman (2001) found bias for pain descriptors to be a significant predictor of patient health-care cost....
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..., 2007), the latter has been associated with hypervigilance for threat (Beck et al., 1985). Patients with chronic pain may therefore be particularly vulnerable to ruminating or worrying over pain-related information. Research has found worry and rumination to be common in patients with chronic pain, which does not arise from general psychopathology (De Vlieger, Crombez, & Eccleston, 2006; Eccleston, Crombez, Aldrich, & Stannard, 2001). The results of the current meta-analysis are supportive of such processes of rumination, as shown via pronounced biases during longer stimuli presentation times. Furthermore, theMisdirected Problem-SolvingModel (Eccleston & Crombez, 2007) proposes worry to result in hypervigilance for pain and pain information. This remains to be specifically tested, but is suggestive that biases at shorter presentation times may also be driven by this variable. Alternatively, biases at this shorter stage may arise due to different factors. For example, numerous triggers of pain exist, which is particularly true for chronic headache (Martin & MacLeod, 2009). Patients with pain may therefore scan their environment for relevant trigger information in an attempt to avoid them. Kelman (2007) has argued avoidance of all triggers to be both unrealistic and stressinducing, the latter of which is itself a very commonly reported trigger in headache....
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..., 2007), the latter has been associated with hypervigilance for threat (Beck et al., 1985). Patients with chronic pain may therefore be particularly vulnerable to ruminating or worrying over pain-related information. Research has found worry and rumination to be common in patients with chronic pain, which does not arise from general psychopathology (De Vlieger, Crombez, & Eccleston, 2006; Eccleston, Crombez, Aldrich, & Stannard, 2001). The results of the current meta-analysis are supportive of such processes of rumination, as shown via pronounced biases during longer stimuli presentation times. Furthermore, theMisdirected Problem-SolvingModel (Eccleston & Crombez, 2007) proposes worry to result in hypervigilance for pain and pain information. This remains to be specifically tested, but is suggestive that biases at shorter presentation times may also be driven by this variable. Alternatively, biases at this shorter stage may arise due to different factors. For example, numerous triggers of pain exist, which is particularly true for chronic headache (Martin & MacLeod, 2009). Patients with pain may therefore scan their environment for relevant trigger information in an attempt to avoid them. Kelman (2007) has argued avoidance of all triggers to be both unrealistic and stressinducing, the latter of which is itself a very commonly reported trigger in headache. Once again, the notion that attentional bias may be implicated in the causation and maintenance of pain is highlighted. It is important for future research to fully explore this possibility, along with the role worry, rumination and trigger avoidance play in attentional bias. The presence of attentional bias in chronic pain may have a range of implications for the patient. Pain itself demands attentional resources (Eccleston & Crombez, 1999), which humans possess in limited quantities. As a result, detrimental effects have been commonly found in attention-demanding tasks (e.g. Kuhajda, Thorn, Klinger, & Rubin, 2002; Veldhuijzen et al., 2006). As attentional bias also demands a portion of an individual's cognitive resources, even greater load is placed upon the patient. Patients who demonstrate attentional bias may therefore be particularly vulnerable to experiencing detrimental effects in general cognitive performance. The implications of such effects upon everyday functioning could be wide-ranging, including negative impacts upon employment, academic performance, and outcomes of psychological interventions to provide a few examples. Furthermore, bias may also be indicative of patient coping. Investigating recall bias in 63 patients with lower back pain, Pincus and Newman (2001) found bias for pain descriptors to be a significant predictor of patient health-care cost. Evidence therefore supports the notion that cognitive biases in chronic pain are linked to patient functioning, although it is important to add that causality remains unknown. While attentional bias research has considered emotional functioning, there is a need for more in-depth investigation into the effects of bias upon daily functioning. It remains unknownwhether attentional bias is associated with increased treatment-seeking behaviours, including utilisation of traditional and alternative therapies, increased use of analgesic medications, or increased use of maladaptive coping strategies such as alcohol or recreational drug use. All are likely to have implications for the individual, their families, and society in general. Due to the issue of causality, longitudinal research will be especially beneficial. Patientswith attentional biasmay be appropriate targets for psychological interventions such as cognitive behavioural therapy (CBT). CBT is commonly used in pain management programmes (Gatchel & Rollings, 2008), although more appropriate targeting of interventions may be achieved through an understanding of any cognitive bias patients' may hold. Supporting this, Pincus and Morley (2001) have noted that paradigms measuring bias in information-processing may be of clinical use, identifying patients who would benefit from psychological interventions, and may also be used to test patient relapse....
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..., 2007), the latter has been associated with hypervigilance for threat (Beck et al., 1985). Patients with chronic pain may therefore be particularly vulnerable to ruminating or worrying over pain-related information. Research has found worry and rumination to be common in patients with chronic pain, which does not arise from general psychopathology (De Vlieger, Crombez, & Eccleston, 2006; Eccleston, Crombez, Aldrich, & Stannard, 2001). The results of the current meta-analysis are supportive of such processes of rumination, as shown via pronounced biases during longer stimuli presentation times. Furthermore, theMisdirected Problem-SolvingModel (Eccleston & Crombez, 2007) proposes worry to result in hypervigilance for pain and pain information. This remains to be specifically tested, but is suggestive that biases at shorter presentation times may also be driven by this variable. Alternatively, biases at this shorter stage may arise due to different factors. For example, numerous triggers of pain exist, which is particularly true for chronic headache (Martin & MacLeod, 2009). Patients with pain may therefore scan their environment for relevant trigger information in an attempt to avoid them. Kelman (2007) has argued avoidance of all triggers to be both unrealistic and stressinducing, the latter of which is itself a very commonly reported trigger in headache. Once again, the notion that attentional bias may be implicated in the causation and maintenance of pain is highlighted. It is important for future research to fully explore this possibility, along with the role worry, rumination and trigger avoidance play in attentional bias. The presence of attentional bias in chronic pain may have a range of implications for the patient. Pain itself demands attentional resources (Eccleston & Crombez, 1999), which humans possess in limited quantities. As a result, detrimental effects have been commonly found in attention-demanding tasks (e.g. Kuhajda, Thorn, Klinger, & Rubin, 2002; Veldhuijzen et al., 2006). As attentional bias also demands a portion of an individual's cognitive resources, even greater load is placed upon the patient. Patients who demonstrate attentional bias may therefore be particularly vulnerable to experiencing detrimental effects in general cognitive performance. The implications of such effects upon everyday functioning could be wide-ranging, including negative impacts upon employment, academic performance, and outcomes of psychological interventions to provide a few examples. Furthermore, bias may also be indicative of patient coping. Investigating recall bias in 63 patients with lower back pain, Pincus and Newman (2001) found bias for pain descriptors to be a significant predictor of patient health-care cost. Evidence therefore supports the notion that cognitive biases in chronic pain are linked to patient functioning, although it is important to add that causality remains unknown. While attentional bias research has considered emotional functioning, there is a need for more in-depth investigation into the effects of bias upon daily functioning. It remains unknownwhether attentional bias is associated with increased treatment-seeking behaviours, including utilisation of traditional and alternative therapies, increased use of analgesic medications, or increased use of maladaptive coping strategies such as alcohol or recreational drug use. All are likely to have implications for the individual, their families, and society in general. Due to the issue of causality, longitudinal research will be especially beneficial. Patientswith attentional biasmay be appropriate targets for psychological interventions such as cognitive behavioural therapy (CBT). CBT is commonly used in pain management programmes (Gatchel & Rollings, 2008), although more appropriate targeting of interventions may be achieved through an understanding of any cognitive bias patients' may hold. Supporting this, Pincus and Morley (2001) have noted that paradigms measuring bias in information-processing may be of clinical use, identifying patients who would benefit from psychological interventions, and may also be used to test patient relapse. While this has not been specifically addressed in former research, Dehghani et al. (2004) found participation in a CBT programme designed to reduce pain-related fears resulted in a significant decrease in attentional bias towards sensory pain stimuli in a sample of chronic musculoskeletal pain patients. As these researchers used the visual-probe task, support is provided for the clinical implementation of this particular paradigm. Recently, research has considered the benefits of modifying cognitive bias in anxiety disorders. Using the visual-probe task, Amir, Beard, Burns, and Bomyea (2009) reported significant reductions in both attentional bias and anxiety in individuals with generalised anxiety disorder following an attention modification programme....
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...bias towards pain stimuli relative to neutral/non-pain stimuli) (Andersson & Haldrup, 2003; Beck, Freeman, Shipherd, Hamblen, & Lackner, 2001; Crombez, Hermans, & Adriaensen, 2000; Snider, Asmundson, & Wiese, 2000). However, a metaanalysis of data from five investigations revealed significant mean difference estimates for both sensory and affective pain words, indicating participants with chronic pain to selectively attend to such stimuli to a significantly greater degree than healthy controls (Roelofs, Peters, Zeegers, & Vlaeyen, 2002). The visual-probe task (MacLeod, Mathews, & Tata, 1986) is a computerised paradigm which simultaneously presents pairs of stimuli that compete for attention for a pre-determined length of time. Following this presentation, both stimuli are removed, with a visual probe (e.g. a dot) replacing one of the stimuli. Participants are required to indicate the location of this probe as quickly and accurately as possible (see below for a detailed description of this paradigm). Chronic pain research using the visual-probe task has also produced mixed results, although to date no specific review of this literature has been published. Pincus and Morley (2001) provided a review of cognitive biases in chronic pain, including those in memory, interpretation, and attention....
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"Attentional bias towards pain-relat..." refers background or result in this paper
...According to Vlaeyen and Linton (2000), high fear of pain results in a hypervigilance for both pain and pain-related information, with patients demonstrating difficulty disengaging from such information....
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...Patients with high fear did not show evidence of significant bias, standing in contrast to the results of Asmundson and Hadjistavropoulos (2007), and conflicting with predictions raised by fear avoidance models (e.g. Vlaeyen & Linton, 2000)....
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...Correlates have been frequently explored in past research, and a number of theoretical models highlight the importance of specific variables, including fear of pain (Vlaeyen & Linton, 2000), pain-related worries (Eccleston & Crombez, 2007), and motivation to remove pain (Van Damme et al., 2010)....
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...While a number of models of pain predict bias for painrelated information and cues (i.e. Eccleston & Crombez, 2007; Pincus & Morley, 2001; Van Damme et al., 2010; Vlaeyen & Linton, 2000), none of these specifically address the time-course of bias in chronic pain....
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