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Recall Bias in Patients with Chronic Low Back Pain: Individual Pain Response Patterns Are More Important Than Pain Itself!

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Abstract

Background

Patients’ cognitive processing of pain-related information as well as their cognitive, affective and behavioral response pattern when experiencing pain in daily life has been shown to be associated with poorer prognosis in low back pain. However, the relationship between specific cognitive processes such as recall of pain-related material and individual pain responses remains unknown.

Purpose

The present study sought to investigate recall bias in patients with chronic low back pain (CLBP) compared to healthy controls. Furthermore, it was aimed to investigate the impact of patients’ individual pain-related responses on recall bias, comparing fear-avoidance response (FAR), endurance response (ER) and adaptive response (AR) patterns.

Method

Thirty-one CLBP patients and 31 controls were tested on a free recall task with three word lists comprising pain words and neutral words. Further, the CLBP group was classified into patients with a FAR, ER and AR pattern, using a short screening including the Avoidance-Endurance Questionnaire (AEQ). Group differences with pain status (CLBP vs. healthy) and AEQ responses (FAR, ER, AR) as between-group factors, word type (pain vs. neutral) as within-group factor and free recall as dependent variable were analysed by means of repeated-measures analysis of (co-) variance.

Results

Results revealed different pain processing of pain words between FAR and ER patterns, whereas CLBP patients as a whole did not differ from the healthy controls. FAR patients displayed significantly less recall than ER patients.

Conclusion

Recall biases in CLBP patients are not only a result of experiencing pain but also effected by patients’ pain response pattern with respect to fear-avoidance versus endurance.

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References

  1. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.

    Article  PubMed  Google Scholar 

  2. Rusu AC, Pincus T, Morley S. Depressed pain patients differ from other depressed groups: examination of cognitive content in a sentence completion task. Pain. 2012;153(9):1898–904.

    Article  PubMed  Google Scholar 

  3. Beck AT, Clark DA. Anxiety and depression: an information processing perspective. Anxiety Res. 1988;1(1):23–36.

    Article  Google Scholar 

  4. Bower GH. Mood and memory. Am Psychol. 1981;36(2):129–48.

    Article  CAS  PubMed  Google Scholar 

  5. Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, van IJzendoorn MH. Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007;133(1):1–24.

    Article  PubMed  Google Scholar 

  6. Gotlib IH, Joormann J. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010;6(1):285–312.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Pincus T, Morley S. Cognitive-processing bias in chronic pain: a review and integration. Psychol Bull. 2001;127(5):599–617.

    Article  CAS  PubMed  Google Scholar 

  8. Pearce SA, Isherwood S, Hrouda D, Richardson PH, Erskine A, Skinner J. Memory and pain: tests of mood congruity and state dependent learning in experimentally induced and clinical pain. Pain. 1990;43(2):187–93.

    Article  CAS  PubMed  Google Scholar 

  9. Hasenbring MI, Verbunt JA. Fear-avoidance and endurance-related responses to pain: new models of behavior and their consequences for clinical practice. Clin J Pain. 2010;26(9):747–53.

    Article  PubMed  Google Scholar 

  10. Grebner M, Breme K, Rothoerl R, Woertgen C, Hartmann A, Thome C. Coping and convalescence course after lumbar disk operations. [Coping und Genesungsverlauf nach lumbaler Bandscheibenoperation]. Schmerz. 1999;13(1):19–30.

    Article  CAS  PubMed  Google Scholar 

  11. Hasenbring MI, Hallner D, Klasen B, Streitlein-Böhme I, Willburger R, Rusche H. Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up. Pain. 2012;153(1):211–7.

    Article  PubMed  Google Scholar 

  12. Hasenbring MI, Plaas H, Fischbein B, Willburger R. The relationship between activity and pain in patients 6 months after lumbar disc surgery: do pain-related coping modes act as moderator variables? Eur J Pain. 2006;10(8):701.

    Article  PubMed  Google Scholar 

  13. Duncan GH, Bushnell MC, Lavigne GJ. Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain. 1989;37(3):295–303.

    Article  CAS  PubMed  Google Scholar 

  14. Jensen MP, Turner LR, Turner JA, Romano JM. The use of multiple-item scales for pain intensity measurement in chronic pain patients. Pain. 1996;67(1):35–40.

    Article  CAS  PubMed  Google Scholar 

  15. Klasen BW, Brüggert J, Hasenbring M. Der Beitrag kognitiver Schmerzverarbeitung zur Depressivität bei Rückenschmerzpatienten. Schmerz. 2006;20(5):398–410.

    Article  CAS  PubMed  Google Scholar 

  16. von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.

    Article  Google Scholar 

  17. Hautzinger M, Bailer M, Worall H, Keller F. Beck-Depressions-Inventar (BDI) - Testhandbuch. Bern: Huber; 1995.

    Google Scholar 

  18. Hasenbring MI, Hallner D, Rusu AC. Fear-avoidance- and endurance-related responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ). Eur J Pain. 2009;13(6):620–8.

    Article  PubMed  Google Scholar 

  19. Hasenbring M. Durchhaltestrategien—ein in Schmerzforschung und Therapie vernachlässigtes Phänomen? Schmerz. 1993;7(4):304–13.

    Article  CAS  PubMed  Google Scholar 

  20. Hoppe W. Die Hamburger Schmerz-Adjektiv-Liste (HSAL). Manual. Weinheim: Beltz; 1991.

    Google Scholar 

  21. Geissner E. Die Schmerzempfindungs-Skala (SES) – Handanweisung. Göttingen: Hogrefe; 1996.

    Google Scholar 

  22. Schwibbe M. Zum emotionalen Gehalt von Substantiven, Adjektiven und Verben. Z Exp Angew Psychol. 1981;28(3):486–501.

    Google Scholar 

  23. Hager W, Hasselhorn M. Handbuch deutschsprachiger Wortnormen. Göttingen: Hogrefe; 1994.

    Google Scholar 

  24. Faul F, Erdfelder E, Buchner A, Lang A. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.

    Article  PubMed  Google Scholar 

  25. Edwards L, Pearce S, Collett B, Pugh R. Selective memory for sensory and affective information in chronic pain and depression. Br J Clin Psychol. 1992;31(2):239–48.

    Article  PubMed  Google Scholar 

  26. Busch H, Montgomery W, Melin B, Lundberg U. Visuospatial and verbal memory in chronic pain patients: an explorative study. Pain Pract. 2006;6(3):179–85.

    Article  PubMed  Google Scholar 

  27. Williams J, Hadjistavropoulos T, Asmundson GJ. The effects of age and fear of pain on attentional and memory biases relating to pain and falls. Anxiety Stress Coping. 2005;18(1):53–69.

    Article  Google Scholar 

  28. Mitte K. Memory bias for threatening information in anxiety and anxiety disorders: a meta-analytic review. Psychol Bull. 2008;134(6):886–911.

    Article  PubMed  Google Scholar 

  29. LeDoux JE. Emotion: clues from the brain. Annu Rev Psychol. 1995;46(1):209–35.

    Article  CAS  PubMed  Google Scholar 

  30. LeDoux JE. The emotional brain: the mysterious underpinnings of emotional life: the emotional brain: the mysterious underpinnings of emotional life. New York: Simon & Schuster; 1996.

    Google Scholar 

  31. Öhman A. Fear and anxiety as emotional phenomena: clinical phenomenology, evolutionary perspectives, and information-processing mechanisms. In: Lewis M, Haviland JM, editors. Handbook of emotions. New York: Guilford Press; 1993. p. 511–36.

    Google Scholar 

  32. Koster EH, Verschuere B, Crombez G, van Damme S. Time-course of attention for threatening pictures in high and low trait anxiety. Behav Res Ther. 2005;43(8):1087–98.

    Article  PubMed  Google Scholar 

  33. Mathews A. Why worry? The cognitive function of anxiety. Behav Res Ther. 1990;28(6):455–68.

    Article  CAS  PubMed  Google Scholar 

  34. Mogg K, Bradley BP. A cognitive-motivational analysis of anxiety. Behav Res Ther. 1998;36(9):809–48.

    Article  CAS  PubMed  Google Scholar 

  35. Mogg K, Mathews A, Weinman J. Memory bias in clinical anxiety. J Abnorm Psychol. 1987;96(2):94–8.

    Article  CAS  PubMed  Google Scholar 

  36. Rinck M, Becker ES. Spider fearful individuals attend to threat, then quickly avoid it: evidence from eye movements. J Abnorm Psychol. 2006;115(2):231–8.

    Article  PubMed  Google Scholar 

  37. Roelofs J, Peters ML, van der Zijden M, Thielen FG, Vlaeyen JW. Selective attention and avoidance of pain-related stimuli: a dot-probe evaluation in a pain-free population. J Pain. 2003;4(6):322–8.

    Article  PubMed  Google Scholar 

  38. Rohner J. The time-course of visual threat processing: high trait anxious individuals eventually avert their gaze from angry faces. Cogn Emot. 2002;16(6):837–44.

    Article  Google Scholar 

  39. Gray JA. The behavioral inhibition system: a possible substrate for anxiety. In: Feldman MP, Broadhurst A, editors. Theoretical and experimental bases of behavior therapies. London: John Wiley & Sons; 1976. p. 3–41.

    Google Scholar 

  40. Luecken LJ, Tartaro J, Appelhans B. Strategic coping responses and attentional biases. Cogn Ther Res. 2004;28(1):23–37.

    Article  Google Scholar 

  41. Wenzlaff RM, Wegner DM. Thought Suppression. Annu Rev Psychol. 2000;51(1):59–91.

    Article  CAS  PubMed  Google Scholar 

  42. Kircanski K, Craske MG, Bjork RA. Thought suppression enhances memory bias for threat material. Behav Res Ther. 2008;46(4):462–76.

    Article  PubMed  Google Scholar 

  43. McNally RJ, Metzger LJ, Lasko NB, Clancy SA, Pitman RK. Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder. J Abnorm Psychol. 1998;107(4):596–601.

    Article  CAS  PubMed  Google Scholar 

  44. Wilhelm S. Directed forgetting in obsessive-compulsive disorder. Behav Res Ther. 1996;34(8):633–41.

    Article  CAS  PubMed  Google Scholar 

  45. Vlaeyen JWS, Morley S, Linton SJ, Boersma K, de Jong J. Pain-related fear: exposure based treatment for chronic pain. IASP Press 2012.

  46. Plaas H, Sudhaus S, Willburger R, Hasenbring MI. Physical activity and low back pain: the role of subgroups based on the avoidance-endurance model. Disabil Rehabil. 2014;36(9):749–55.

    Article  PubMed  Google Scholar 

  47. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press; 1983.

    Google Scholar 

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Acknowledgments

We thank the subjects for their participation, consent and cooperation in the present study. We would also like to thank the helpful comments of the reviewers.

Conflict of Interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstraße 150, 44780, Bochum, Germany

    Zohra Karimi, Alisha Pilenko, Sabine Melanie Held & Monika Ilona Hasenbring

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  1. Zohra Karimi
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  2. Alisha Pilenko
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  3. Sabine Melanie Held
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  4. Monika Ilona Hasenbring
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Correspondence to Zohra Karimi.

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Karimi, Z., Pilenko, A., Held, S.M. et al. Recall Bias in Patients with Chronic Low Back Pain: Individual Pain Response Patterns Are More Important Than Pain Itself!. Int.J. Behav. Med. 23, 12–20 (2016). https://doi.org/10.1007/s12529-015-9499-6

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