Dimitri Van Ryckeghem

Attentional bias to pain-related information: A meta-analysis

Summary Individuals who experience chronic pain display an attentional bias towards pain‐related words or pictures, but the bias is small and largely variable in effect. Abstract This meta‐analysis investigated whether attentional bias, that is, the preferential allocation of attention to information that is related to pain, is a ubiquitous phenomenon. We also investigated whether attentional bias effects are related to the methodological quality of the study, to procedural differences in their measurement, or to individual differences in pain severity, pain‐related fear, anxiety, and depression. Results indicated that individuals who experience chronic pain (n = 1023) display an attentional bias towards pain‐related words or pictures, but this bias was of a small effect size (d = 0.134), and did not differ from that in control groups (d = 0.082; n = 1398). No evidence was found for an attentional bias towards pain‐related words and pictures for acute pain (d = 0.049), procedural pain (d = 0.142), and experimental pain (d = 0.069). However, research in which attentional bias towards signals of impending experimental pain in healthy volunteers was investigated, revealed an attentional bias of medium effect size (d = 0.676). Moderator analyses in the chronic pain group identified important procedural variables that affected the presence and magnitude of an attentional bias towards pain‐related words and pictures, that is, type and exposure time of pain‐related information. None of the individual difference variables affected the magnitude of the attentional bias. Implications of current findings and future directions are discussed.

A meta-analysis of serious digital games for healthy lifestyle promotion.

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed.

The role of motivation in distracting attention away from pain: An experimental study

&NA; Research on the effectiveness of distraction as a method of pain control is inconclusive. One mechanism pertains to the motivational relevance of distraction tasks. In this study the motivation to engage in a distraction task during pain was experimentally manipulated. Undergraduate students (N = 73) participated in a cold pressor test (CPT) and were randomly assigned to three groups: a distraction‐only group performed a tone‐detection task during the CPT, a motivated‐distraction group performed the same task and received a monetary reward for good task performance, and a control group did not perform the tone‐detection task. Results indicated that engagement in the distraction task was better in the motivated‐distraction group in comparison with the distraction‐only group. Participants in both distraction groups experienced less pain compared to the control group. There were no overall differences in pain intensity between the two distraction groups. The effect of distraction was influenced by the level of catastrophic thinking about pain. For low catastrophizers, both distraction groups reported less pain as compared to the non‐distracted control group. This was not the case for high catastrophizers. For high catastrophizers it mattered whether the distraction task was motivationally relevant: high catastrophizers reported less intense pain in the motivated‐distraction group, as compared to the non‐distracted control group. We conclude that increasing the motivational relevance of the distraction task may increase the effects of distraction, especially for those who catastrophize about pain.

No pain no gain? Pursuing a competing goal inhibits avoidance behavior.

Summary Pursuing valuable goals reduces pain‐related avoidance behavior and the relation between fear and avoidance. This shows the need for a dynamic, contextual‐motivational view on disability. Abstract This experiment investigated pain‐related avoidance behavior in context of competing goals. Participants (N = 56) were presented trials of 2 different tasks of which 1 task could produce pain. They were free to decide whether or not to perform trials of these tasks. In half of the participants, a competing goal was activated by instructing them that they would receive a monetary reward corresponding to the number of pain task trials actually performed (competition group). In the other half of the participants, no competing goal was installed (control group). Results showed that the competition group showed less frequent avoidance behavior than the control group. Furthermore, the association between pain‐related avoidance behavior and fear of pain was smaller in the competition group than in the control group. The findings indicate that the emergence of pain‐related avoidance behavior depends upon the motivational context, and that the association between pain‐related fear and avoidance is not stable. This study has implications for our understanding of disability, and points to the need to consider avoidance behavior within a broad context of multiple, often competing, goals.

Distraction from pain and executive functioning: an experimental investigation of the role of inhibition, task switching and working memory

Although many studies have investigated the effectiveness of distraction as a method of pain control, the cognitive processes by which attentional re‐direction is achieved, remain unclear. In this study the role of executive functioning abilities (inhibition, task switching and working memory) in the effectiveness of distraction is investigated. We hypothesized that the effectiveness of distraction in terms of pain reduction would be larger in participants with better executive functioning abilities. Ninety‐one undergraduate students first performed executive functioning tasks, and subsequently participated in a cold pressor task (CPT). Participants were randomly assigned to (1) a distraction group, in which an attention‐demanding tone‐detection task was performed during the CPT, or (2) a control group, in which no distraction task was performed. Participants in the distraction group reported significantly less pain during the CPT, but the pain experience was not influenced by executive functioning abilities. However, the performance on the distraction task improved with better inhibition abilities, indicating that inhibition abilities might be important in focussing on a task despite the pain.

When you dislike patients, pain is taken less seriously

Summary Patients’ likability—manipulated by means of an evaluative conditioning procedure—influences observers’ pain estimations and sensitivity to the pain. Abstract This study examined the influence of patients’ likability on pain estimations made by observers. Patients’ likability was manipulated by means of an evaluative conditioning procedure: pictures of patients were combined with either positive, neutral, or negative personal traits. Next, videos of the patients were presented to 40 observers who rated the pain. Patients were expressing no, mild‐, or high‐intensity pain. Results indicated lower pain estimations as well as lower perceptual sensitivity toward pain (i.e., lower ability to discriminate between varying levels of pain expression) with regard to patients who were associated with negative personal traits. The effect on pain estimations was only found with regard to patients expressing high‐intensity pain. There was no effect on response bias (i.e., the overall tendency to indicate pain). These findings suggest that we take the pain of patients we do not like less seriously than the pain of patients we like.

Children’s selective attention to pain and avoidance behaviour: The role of child and parental catastrophizing about pain

Summary Children’s selective attention to pain and its impact upon child avoidance behaviour is differentially sensitive to specific dimensions of child and parental catastrophizing. Abstract The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing about pain (ie, rumination, magnification, and helplessness). Participants were 59 children (31 boys) aged 10‐16 years and one of their parents (41 mothers). Children performed a dot‐probe task in which child facial pain displays of varying pain expressiveness were presented. Child avoidance behaviour was indexed by child pain tolerance during a cold‐pressor task. Children and parents completed measures of child and parent pain catastrophizing, respectively. Findings indicated that both the nature of child selective attention to pain and the impact of selective attention upon child avoidance behaviour were differentially sensitive to specific dimensions of child and parental catastrophizing. Specifically, findings showed greater tendency to shift attention away from pain faces (ie, attentional avoidance) among children reporting greater pain magnification. A similar pattern was observed in terms of parental characteristics, such that children increasingly shifted attention away from pain with increasing levels of parental rumination and helplessness. Furthermore, child attentional avoidance was associated with greater avoidance behaviour (ie, lower pain tolerance) among children reporting high levels of pain magnification and those whose parents reported greater rumination about pain. The current findings corroborate catastrophizing as a multidimensional construct that may differentially impact outcomes and attest to the importance of assessing both child and parental characteristics in relation to child pain‐related attention and avoidance behaviour. Further research directions are discussed.

The role of spatial attention in attentional control over pain: an experimental investigation

Distraction is a common method of pain control that is often found to be effective. However, it is still largely unexplored which components of distraction are responsible for its effects. This study investigated the role of the spatial location of task-relevant stimuli in the effectiveness of distraction. Two experiments were performed in which the spatial location of visual stimuli during nociceptive input was manipulated. In a first experiment, we tested whether the reaction to nociceptive information is slower when visual stimuli are presented at a different spatial location than at the same spatial location. In a second experiment, we examined whether the manipulation of spatial location affects the experience of pain. Overall, results indicated that directing attention away from the pain location results in a slower response to painful stimuli and a reduction in pain. It may be concluded that the analgesic effect of distraction is at least partly the result of the spatial location of the distracting information.

The predictive value of attentional bias towards pain-related information in chronic pain patients: a diary study.

Summary Attentional bias towards pain‐related information moderates the positive relationship between 1) pain severity and disability and 2) pain severity and distractibility in chronic pain patients. ABSTRACT Theoretical accounts of chronic pain hypothesize that attentional bias towards pain‐related information is a maintaining or exacerbating factor, fuelling further pain, disability, and distress. However, empirical research testing this idea is currently lacking. In the present study, we investigated whether attentional bias towards pain‐related information predicts daily pain‐related outcomes in a sample of chronic pain patients (n = 69; Mage = 49.64 years; 46 females). During an initial laboratory session, attentional bias to pain‐related information was assessed using a modified spatial cueing task. In advance, patients completed a number of self‐report measures assessing current pain intensity, current disability, and pain duration. Subsequently, daily pain outcomes (self‐reported pain severity, disability, avoidance behaviour, and distractibility) were measured for 2 weeks by means of an electronic diary. Results indicated that, although an attentional bias towards pain‐related information was associated with the current level of disability and pain severity, it had no additional value above control variables in predicting daily pain severity, avoidance, distractibility, and disability. Attentional bias towards pain‐related information did, however, moderate the relationship between daily pain severity and both daily disability and distractibility, indicating that, particularly in those patients with a strong attentional bias, increases in pain were associated with increased disability and distractibility. The use of interventions that diminish attentional bias may therefore be helpful to reduce daily disability and the level of distraction from current tasks despite the presence of pain in chronic pain patients.

Attentional bias towards pain-related information diminishes the efficacy of distraction.

Summary People who display a large attentional bias towards predictive cues of pain or who initially experience the pain as more painful benefit less from distraction during subsequent pain induction. ABSTRACT Distraction is a strategy that is commonly used to cope with pain. Results concerning the efficacy of distraction from both experimental and clinical studies are variable, however, and indicate that its efficacy may depend on particular circumstances. Several models propose that distraction may be less effective for people who display a large attentional bias towards pain‐related information. This hypothesis was tested in an experimental context with 53 pain‐free volunteers. First, attentional bias towards cues signalling the occurrence of pain (electrocutaneous stimuli) and towards words describing the sensory experience of this painful stimulus was independently assessed by means of 2 behavioural paradigms (respectively, spatial cueing task and dot‐probe task). This was followed by a subsequent distraction task during which the efficacy of distraction, by directing attention away from the electrocutaneous stimuli, was tested. In addition, state–trait anxiety, catastrophic thinking, and initial pain intensity were measured. Results indicated that people who display a large attentional bias towards predictive cues of pain or who initially experience the pain as more painful benefit less from distraction on a subsequent test. No effects were found between attentional bias towards pain words, state–trait anxiety, catastrophic thinking, and the efficacy of distraction. Current findings suggest that distraction should not be used as a ‘one size fits all’ method to control pain, but only under more specific conditions.