Advertisement

Journal of Behavioral Medicine

, Volume 36, Issue 4, pp 371–378 | Cite as

Attention to pain and fear of pain in patients with chronic pain

  • Geert CrombezEmail author
  • Ilse Viane
  • Christopher Eccleston
  • Jacques Devulder
  • Liesbet Goubert
Article

Abstract

To investigate how acceptance of illness affects chronic pain in terms of attention towards pain and fearful thinking of pain. 62 participants (50 women) with chronic pain carried a palmtop computer for 2 weeks. Eight times each day auditory signals were delivered to cue participants to complete questions about their experience. Multilevel analyses indicated that on moments with more intense pain, more fearful thinking about pain, and less positive emotions, attention to pain was increased. Illness acceptance did not moderate the relation between pain intensity and attention to pain. Results further indicated that on moments with more intense pain, more negative emotions, and less positive emotions, fearful thinking about pain was increased. Of particular interest was the finding that the relationship between pain intensity and fearful thinking about pain was less strong for those high in acceptance. Pain captures attention and elicits fearful thinking about pain. Acceptance may be a useful avenue to lower negative thinking about pain, and to increase well-being in patients with chronic illnesses.

Keywords

Chronic pain Acceptance Attention Fear 

Notes

Acknowledgments

This study was supported by a research grant from the Fund for Scientific Research, Flanders (Belgium).

References

  1. Chapman, C. R. (1978). Pain: The perception of noxious events. In R. A. Sternbach (Ed.), The psychology of pain (pp. 169–202). New York: Raven Press.Google Scholar
  2. Cioffi, D. (1991). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation. Psychological Bulletin, 109, 25–41. doi: 10.1037//0033-2909.109.1.25 PubMedCrossRefGoogle Scholar
  3. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. San Diego, CA: McGraw-Hill.Google Scholar
  4. Crombez, G., Baeyens, F., & Eelen, P. (1994). Sensory and temporal information about impending pain: The influence of predictability on pain. Behaviour Research and Therapy, 32, 611–622. doi: 10.1016/0005-7967(94)90015-9 PubMedCrossRefGoogle Scholar
  5. Crombez, G., Eccleston, C., Baeyens, F., & Eelen, P. (1996). The disruptive nature of pain: An experimental investigation. Behaviour Research and Therapy, 34, 911–918. doi: 10.1016/S0005-7967(96)00058-7 PubMedCrossRefGoogle Scholar
  6. Crombez, G., Eccleston, C., Baeyens, F., & Eelen, P. (1997). Habituation and the interference of pain with task performance. Pain, 70, 149–154. doi: 10.1016/S0304-3959(96)03304-0 PubMedCrossRefGoogle Scholar
  7. Crombez, G., Eccleston, C., Baeyens, F., & Eelen, P. (1998). When somatic information threatens, catastrophic thinking enhances attentional interference. Pain, 75, 187–198. doi: 10.1016/S0304-3959(97)00219-4 PubMedCrossRefGoogle Scholar
  8. Crombez, G., Eccleston, C., Baeyens, F., Van Houdenhove, B., & Van den Broeck, A. (1999). Attention to pain is dependent upon pain-related fear. Journal of Psychosomatic Research, 47, 639–644. doi: 10.1016/S0022-3999(99)00046-X CrossRefGoogle Scholar
  9. Crombez, G., Van Damme, S., & Eccleston, C. (2005). Hypervigilance to pain: An experimental and clinical analysis. Pain, 116, 4–7. doi: 10.1016/j.pain.2005.03.035 PubMedCrossRefGoogle Scholar
  10. Cruise, C. E., Broderick, J. E., Porter, L., Kaell, A., & Stone, A. A. (1996). Reactive effects of diary self-assessment in chronic pain patients. Pain, 67, 253–258. doi: 10.1016/0304-3959(96)03125-9 PubMedCrossRefGoogle Scholar
  11. Csikszentmihalyi, M., & Larsen, R. E. (1987). Validity and reliability of the experience sampling method. The Journal of Nervous and Mental Disease, 175, 526–536.PubMedCrossRefGoogle Scholar
  12. Davis, M. C., Zautra, A. J., & Smith, B. W. (2004). Chronic pain, stress, and the dynamics of affective differentiation. Journal of Personality, 72, 1133–1159. doi: 10.1111/j.1467-6494.2004.00293.x PubMedCrossRefGoogle Scholar
  13. De Vlieger, P., Van den Bussche, E., Eccleston, C., & Crombez, G. (2006). Finding a solution to the problem of pain: Conceptual formulation and the development of the pain solutions questionnaire (PaSol). Pain, 123, 285–293. doi: 10.1016/j.pain.2006.03.005 PubMedCrossRefGoogle Scholar
  14. de Wied, M., & Verbaten, M. N. (2001). Affective pictures processing, attention, and pain tolerance. Pain, 90, 163–172. doi: 10.1016/S0304-3959(00)00400-0 PubMedCrossRefGoogle Scholar
  15. Delespaul, P. (1995). Assessing schizophrenia in daily life—The experience sampling method. Maastricht: Maastricht University Press.Google Scholar
  16. Eccleston, C. (1994). Chronic pain and attention: A cognitive approach. British Journal of Clinical Psychology, 33, 535–547.PubMedCrossRefGoogle Scholar
  17. Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356–366. doi: 10.1037/0033-2909.125.3.356 PubMedCrossRefGoogle Scholar
  18. Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: A misdirected problem solving model. Pain, 132, 233–236. doi: 10.1016/j.pain.2007.09.014 PubMedCrossRefGoogle Scholar
  19. Erskine, A., Morley, S., & Pearce, S. (1990). Memory for pain: A review. Pain, 41, 225–265. doi: 10.1016/0304-3959(90)90002-U CrossRefGoogle Scholar
  20. Evers, A. W. M., Kraaimaat, F. W., van Lankveld, W., Jongen, P. J. H., Jacobs, J. W. G., & Bijlsma, J. W. J. (2001). Beyond unfavorable thinking: The illness cognition questionnaire for chronic diseases. Journal of Consulting and Clinical Psychology, 69, 1026–1036. doi: 10.1037/0022-006X.69.6.1026 PubMedCrossRefGoogle Scholar
  21. Eysenck, M. W. (1992). Anxiety: The cognitive perspective. Hillsdale: Lawrence Erlbaum Associates.Google Scholar
  22. Fredrickson, B. L., & Joiner, T. (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science, 13, 172–175. doi: 10.1111/1467-9280.00431 PubMedCrossRefGoogle Scholar
  23. Goubert, L., Crombez, G., & Van Damme, S. (2004). The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: A structural equations approach. Pain, 107, 234–241. doi: 10.1016/j.pain.2003.11.005 PubMedCrossRefGoogle Scholar
  24. Hamilton, N. A., Karoly, P., & Kitzman, H. (2004). Self-regulation and chronic pain: The role of emotion. Cognitive Therapy and Research, 28, 559–576. doi: 10.1023/B:COTR.0000045565.88145.76 CrossRefGoogle Scholar
  25. Heyneman, N. E., Fremouw, W. J., Gano, D., Kirkland, F., & Leiden, L. (1990). Individual differences and the effectiveness of different coping strategies for pain. Cognitive Therapy and Research, 14, 63–77. doi: 10.1007/BF01173525 CrossRefGoogle Scholar
  26. Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic data analysis. New York: Cambridge University Press.Google Scholar
  27. Kratz, A. L., Davis, M. C., & Zautra, A. J. (2007). Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients. Annals of Behavioral Medicine, 33, 291–301. doi: 10.1007/BF02879911 PubMedCrossRefGoogle Scholar
  28. Kreft, I., & de Leeuw, J. (1998). Introducing multilevel modeling. London: Sage Publications.Google Scholar
  29. Larsen, R., & Diener, E. (1992). Promises and problems with the circumplex model of emotion. In M. S. Clarke (Ed.), Emotion review of personality and social psychology (pp. 25–59). Newbury Park, CA: Sage.Google Scholar
  30. Lauwerier, E., Crombez, G., Van Damme, S., Goubert, L., Vogelaers, D., & Evers, A. W. M. (2010). The construct validity of the illness cognition questionnaire: The robustness of the three-factor structure across patients with chronic pain and chronic fatigue. International Journal of Behavioural Medicine, 17, 90–96. doi: 10.1007/s12529-009-9059-z CrossRefGoogle Scholar
  31. Legrain, V., Van Damme, S., Eccleston, C., Davis, K. D., Seminowics, D. A., & Crombez, G. (2009). A neurocognitive model of attention to pain: Behavioral and neuroimaging evidence. Pain, 144, 230–232. doi: 10.1016/j.pain.2009.03.020 PubMedCrossRefGoogle Scholar
  32. McCracken, L. M. (1997). ‘Attention’ to pain in persons with chronic pain: A behavioural approach. Behaviour Research and Therapy, 28, 271–284. doi: 10.1016/S0005-7894(97)80047-0 CrossRefGoogle Scholar
  33. McCracken, L. M. (1998). Learning to live with chronic pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain, 105, 197–204. doi: 10.1016/S0304-3959(97)00146-2 CrossRefGoogle Scholar
  34. McCracken, L. M. (2007). A contextual analysis of attention to chronic pain: What the patient does with their pain might be more important than their awareness or vigilance alone. Journal of Pain, 8, 230–236. doi: 10.1016/j.jpain.2006.08.004 PubMedCrossRefGoogle Scholar
  35. McCracken, L. M., Carson, J. W., Eccleston, C., & Keefe, F. J. (2004a). Acceptance and change in the context of chronic pain. Pain, 109, 4–7. doi: 10.1016/j.pain.2004.02.006 PubMedCrossRefGoogle Scholar
  36. McCracken, L. M., Spertus, I. L., Janeck, A. S., Sinclair, D., & Wetzel, T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283–289. doi: 10.1016/S0304-3959(98)00219-X PubMedCrossRefGoogle Scholar
  37. McCracken, L. M., Vowles, K., & Eccleston, C. (2004b). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166. doi: 10.1016/j.pain.2003.10.012 PubMedCrossRefGoogle Scholar
  38. Moriarty, O., McGuire, B. E., & Finn, D. P. (2011). The effect of pain on cognitive function: A review of clinical and preclinical research. Progress in Neurobiology, 93, 385–404. doi: 10.1016/j.pneurobio.2011.01.002 PubMedCrossRefGoogle Scholar
  39. Nezlek, J. B. (2001). Multilevel random coefficient analyses of event and interval contingent data in social and personality research. Personality and Social Psychology Bulletin, 27, 771–785. doi: 10.1177/0146167201277001 CrossRefGoogle Scholar
  40. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models. Applications and data analysis methods. Newbury Park, CA: Sage.Google Scholar
  41. Roelofs, J., Peters, M. L., McCracken, L. M., & Vlaeyen, J. W. S. (2003). The pain vigilance and awareness questionnaire (PVAQ): Further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain, 101, 299–306. doi: 10.1016/S0304-3959(02)00338-X PubMedCrossRefGoogle Scholar
  42. Shiffman, S., & Stone, A. A. (1998). Introduction to the special section: Ecological momentary assessment in health psychology. Health Psychology, 17, 3–5.CrossRefGoogle Scholar
  43. Stone, A. A., Broderick, J. E., Schwartz, J. E., Shiffman, S., Litcher-Kelly, L., & Calvanese, P. (2003). Intensive momentary reporting of pain with an electronic diary: reactivity, compliance, and patient satisfaction. Pain, 104, 343–351. doi: 10.1016/S0304-3959(03)00040-X PubMedCrossRefGoogle Scholar
  44. Stone, A. A., & Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine, 16, 199–202.Google Scholar
  45. Van Damme, S., Crombez, G., & Eccleston, C. (2002). Retarded disengagement from pain cues: The effects of pain catastrophizing and pain expectancy. Pain, 100, 111–118. doi: 10.1016/S0304-3959(02)00290-7 PubMedCrossRefGoogle Scholar
  46. Van Damme, S., Crombez, G., & Eccleston, C. (2004). Impaired disengagement from pain: The role of catastrophic thinking about pain. Pain, 107, 70–76. doi: 10.1016/j.ejpain.2003.08.005 PubMedCrossRefGoogle Scholar
  47. Vancleef, L. M. G., & Peters, M. L. (2006). Pain catastrophizing, but not injury/illness sensitivity or anxiety sensitivity enhances attentional interference by pain. Journal of Pain, 7, 23–30. doi: 10.1016/j.jpain.2005.04.003 PubMedCrossRefGoogle Scholar
  48. Viane, I., Crombez, G., Eccleston, C., Devulder, J., & De Corte, W. (2004). Acceptance of the unpleasant reality of chronic pain: Effects upon attention to pain and engagement with daily activities. Pain, 112, 282–288. doi: 10.1016/j.pain.2004.09.008 PubMedCrossRefGoogle Scholar
  49. Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., et al. (2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: Empirical evidence and reappraisal. Pain, 106, 65–72. doi: 10.1016/S0304-3959(03)00291-4 PubMedCrossRefGoogle Scholar
  50. Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397–407. doi: 10.1037/0022-006X.76.3.397 PubMedCrossRefGoogle Scholar
  51. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the role of negative affectivity. Psychological Review, 96, 234–254.PubMedCrossRefGoogle Scholar
  52. Wong, W. S., McCracken, L. M., & Fielding, R. (2011). Factorial validity and reliability of the Chinese version of the pain vigilance and awareness questionnaire (ChPVAQ) in a sample of Chinese patients with chronic pain. Pain Medicine, 12, 1018–1025. doi: 10.1111/j.1526-4637.2011.01169.x PubMedCrossRefGoogle Scholar
  53. Zautra, A. J., Johnson, L. M., & Davis, M. C. (2005). Positive affect as a source of resilience for women in chronic pain. Journal of Consulting and Clinical Psychology, 73, 212–220. doi: 10.1037/0022-006X.73.2.212 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Geert Crombez
    • 1
    Email author
  • Ilse Viane
    • 1
  • Christopher Eccleston
    • 2
  • Jacques Devulder
    • 3
  • Liesbet Goubert
    • 1
  1. 1.Department of Experimental Clinical and Health PsychologyGhent UniversityGhentBelgium
  2. 2.Centre for Pain Research, University of BathBathUK
  3. 3.Department of Anesthesia, Pain ClinicUniversity Hospital of GhentGhentBelgium

Personalised recommendations