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

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.

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Notes

  1. Separate analyses with each item of the fearful thinking about pain scale revealed similar effects as the analyses with the two items aggregated.

References

  • 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 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences. San Diego, CA: McGraw-Hill.

    Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • Csikszentmihalyi, M., & Larsen, R. E. (1987). Validity and reliability of the experience sampling method. The Journal of Nervous and Mental Disease, 175, 526–536.

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Delespaul, P. (1995). Assessing schizophrenia in daily life—The experience sampling method. Maastricht: Maastricht University Press.

    Google Scholar 

  • Eccleston, C. (1994). Chronic pain and attention: A cognitive approach. British Journal of Clinical Psychology, 33, 535–547.

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Erskine, A., Morley, S., & Pearce, S. (1990). Memory for pain: A review. Pain, 41, 225–265. doi:10.1016/0304-3959(90)90002-U

    Article  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • Eysenck, M. W. (1992). Anxiety: The cognitive perspective. Hillsdale: Lawrence Erlbaum Associates.

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic data analysis. New York: Cambridge University Press.

    Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Kreft, I., & de Leeuw, J. (1998). Introducing multilevel modeling. London: Sage Publications.

    Google Scholar 

  • 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 

  • 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

    Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models. Applications and data analysis methods. Newbury Park, CA: Sage.

    Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Shiffman, S., & Stone, A. A. (1998). Introduction to the special section: Ecological momentary assessment in health psychology. Health Psychology, 17, 3–5.

    Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Stone, A. A., & Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavioral medicine. Annals of Behavioral Medicine, 16, 199–202.

    Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the role of negative affectivity. Psychological Review, 96, 234–254.

    PubMed  Article  CAS  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

  • 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

    PubMed  Article  Google Scholar 

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Acknowledgments

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

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Correspondence to Geert Crombez.

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Crombez, G., Viane, I., Eccleston, C. et al. Attention to pain and fear of pain in patients with chronic pain. J Behav Med 36, 371–378 (2013). https://doi.org/10.1007/s10865-012-9433-1

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  • DOI: https://doi.org/10.1007/s10865-012-9433-1

Keywords

  • Chronic pain
  • Acceptance
  • Attention
  • Fear