How does distraction work in the management of pain?

Abstract

Engaging in thoughts or activities that distract attention from pain is one of the most commonly used and highly endorsed strategies for controlling pain. The process of distraction appears to involve competition for attention between a highly salient sensation (pain) and consciously directed focus on some other information processing activity. In this article, the evidence for distraction from pain is examined and the qualities of pain, the distractor, and some individual difference variables that have been shown influence the effectiveness of distraction are described. There has been little examination of the use of distraction in chronic pain, but some ancillary evidence suggests that it should be used with caution.

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References and Recommended Reading

  1. 1.

    James W: Psychology: a Briefer Course. London: Macmillan; 1892.

    Google Scholar 

  2. 2.

    Broadbent DE: Perception and Communication. Oxford: Pergamon Press; 1958.

    Google Scholar 

  3. 3.

    Allport A: Visual attention. In Foundation of Cognitive Science. Edited by Posner MI. Hillside, NJ: Erlbaum; 1989:631–682.

    Google Scholar 

  4. 4.

    Kahneman D: Attention and Effort. Englewood Cliffs, NJ: Prentice-Hall; 1973.

    Google Scholar 

  5. 5.

    Isreal JB, Chesney GL, Wickens CD, Donchin E: P 300 and tracking difficulty. Psychophysiology 1980, 17:259–273.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Wickens CD: The structure of attentional resources. In Attention and Performance, edn 8. Edited by Nickerson R. Hillsdale, NJ: Erlbaum; 1980:239–257.

    Google Scholar 

  7. 7.

    Wickens CD: Processing resources in attention. In Varieties of Attention. Edited by Parasuraman R, Davies DR. Orlando: Academic; 1984:63–102.

    Google Scholar 

  8. 8.

    Leventhal H: I know distraction works even though it doesn’t. Health Psychol 1992, 11:208–209.

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    McCaul KD, Mallott JM: Distraction and coping with pain. Psychol Bull 1984, 95:516–533.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Fernandez E, Turk DC: The utility of cognitive coping strategies for altering pain perception: a meta-analysis. Pain 1989, 38:123–135.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Hodes RL, Howland EW, Lightfoot N, Cleeland CS: The effects of distraction on responses to cold pressor pain. Pain 1990, 41:109–114.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    McCaul KD, Monson N, Maki RH: Does distraction reduce pain-produced distress among college students? Health Psychol 1992, 11:210–217.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Johnson MH, Breakwell G, Douglas W, Humphries S: The effects of sensory detection distractors on different measures of pain: How does distraction work? Br J Clin Psychol 1998, 37:141–154.

    PubMed  Google Scholar 

  14. 14.

    Arntz A, De Jong P: Anxiety attention and pain. J Psychosom Res 1993, 37:423–432.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Villemure C, Slotnick BM, Bushnell MC: Effects of odors on pain perception: deciphering the roles of emotion and attention. Pain 2003, 106:101–108.

    PubMed  Article  Google Scholar 

  16. 16.

    Bushnell CM, Villemure C, Duncan GH: Psychophysical and neurophysiological studies of pain modulation by attention. In Psychological Methods of Pain Control: Basic Science and Clinical Perspectives. Edited by Price DD, Duncan CM. Seattle: IASP Press; 2004:99–116. This chapter provides a good summary of the evidence for the modulation of physiologic and neurophysiologic activity by attention.

    Google Scholar 

  17. 17.

    Morley S, Biggs J, Shapiro D: Attention management in chronic pain: a treatment manual. http://www.leeds.ac.uk/ medicine/psychiatry/attman/introduction.htm. Accessed September 5, 2004. This web site contains the entire treatment manual for attention management. The manual’s title indicates that it is suitable for chronic pain. However, the techniques provided also are appropriate for acute pain.

  18. 18.

    Morley S, Shapiro DA, Biggs J: Developing a treatment manual for attention management in chronic pain. Cogn Behav Ther 2004, 33:1–11.

    PubMed  Article  Google Scholar 

  19. 19.

    Hayes RL, Dubner R, Hoffman DS: Neuronal activity in medullary dorsal horn of awake monkeys trained in a thermal discrimination task. II: behavioral responses to thermal and mechanical stimuli. J Neurophysiol 1981, 46:428–443.

    PubMed  CAS  Google Scholar 

  20. 20.

    Bandura A, O’Leary A, Taylor CB, et al.: Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol 1987, 53:563–571.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Porro CA: Functional imaging and pain: behavior, perception, and modulation. Neuroscientist 2003, 9:354–369.

    PubMed  Article  Google Scholar 

  22. 22.

    Rainville P, Duncan GH, Price DD, et al.: Pain affect encoded in human anterior cingulated, but not somatosensory cortex. Science 1997, 277:968–971.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Rainville P: Brain mechanisms of pain affect and pain modulation. Curr Opin Neurobiol 2002, 12:195–204.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Tracey I, Ploghaus A, Gati JS, et al.: Imaging attentional modulation of pain in the periaqueductal grey in humans. J Neurosci 2002, 22:2748–2752.

    PubMed  CAS  Google Scholar 

  25. 25.

    Davis KD, Taylor SJ, Crawley AP, et al.: Functional MRI of pain and attention-related activations in the human cingulate cortex. J Neurophysiol 1997, 77:3370–3380.

    PubMed  CAS  Google Scholar 

  26. 26.

    Bantick SJ, Wise RG, Ploghaus A, et al.: Imaging how attention modulates pain in humans using functional MRI. Brain 2002, 125:310–319.

    PubMed  Article  Google Scholar 

  27. 27.

    Seminowicz DA, Mikulis DJ, Davis KD: Cognitive modulation of pain-related brain responses depends on behavioral strategy. Pain 2004, 112:48–58.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Tracey I, Ploghaus A, Gati JS, et al.: Imaging attentional modulation of pain in the periaqueductal grey in humans. J Neurosci 2002, 22:2748–2752.

    PubMed  CAS  Google Scholar 

  29. 29.

    Melzack R, Wall PD: Pain mechanisms a new theory. Science 1965, 150:971–979.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Eccleston C, Crombez G: Pain demands attention: a cognitiveaffective model of the interruptive function of pain. Psychol Bull 1999, 125:356–366. This review provides a coherent discussion of the salience of pain and reviews some of the evidence regarding the capacity of pain to interrupt ongoing activity.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Eccleston C: Chronic pain and attention: a cognitive approach. Br J Clin Psychol 1994, 33:535–547.

    PubMed  Google Scholar 

  32. 32.

    Crombez G, Eccleston C, Baeyens F, Eelen P: The disruptive nature of pain: an experimental investigation. Behav Res Ther 1996, 34:911–918.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Crombez G, Baeyens F, Eelen P: Sensory and temporal information about impending pain. Behav Res Ther 1994, 32:611–622.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Crombez G, Eccleston C, Baeyens F, Eelen P: Habituation and the interference of pain with task performance. Pain 1997, 70:149–154.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Crombez G, Eccleston C, Baeyens F, Eelen P: Attentional disruption is enhanced by the threat of pain. Behav Res Ther 1998, 36:195–204.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Crombez G, Eccleston C, Baeyens F, Eelen P: When somatic information threatens, catastrophic thinking enhances attentional interference. Pain 1998, 75:187–198.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Crombez G, Eccleston C, Baeyens F, et al.: Attention to chronic pain is dependent upon pain related fear. J Psychosom Res 1999, 47:403–410.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Roelofs J, Peters ML, van der Zijden M, Vlaeyen JW: Does fear of pain moderate the effects of sensory focusing and distraction on cold pressor pain in pain-free individuals. J Pain 2004, 5:250–256.

    PubMed  Article  Google Scholar 

  39. 39.

    Eccleston C, Crombez G, Aldrich S, Stannard C: Attention and somatic awareness in chronic pain. Pain 1997, 72:209–215.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Van Damme S, Crombez G, Eccleston C: Disengagement from pain: the role of catastrophic thinking about pain. Pain 2004, 70–76.

  41. 41.

    Sullivan MJ, Stanish W, Waite H, et al.: Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain 1998, 77:253–260.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000, 85:317–332.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Goubert L, Crombez G, Van Damme S: The role of neuroticism, pain catastrophizing, and pain-related fear in vigilance to pain: a structural equations approach. Pain 2004, 107:234–241.

    PubMed  Article  Google Scholar 

  44. 44.

    Peters ML, Vlaeyen JW, Kunnen AM: Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients. Behav Res Ther 2002, 40:85–103.

    PubMed  Article  Google Scholar 

  45. 45.

    Rybstein-Blinchik E: Effects of different cognitive strategies on chronic pain experience. J Behav Med 1979, 2:93–101.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Johnson MH, Petrie SM: The effects of distraction on exercise and cold pressor tolerance for chronic low back pain sufferers. Pain 1997, 69:43–48.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Kleinke CL: How chronic pain patients cope with pain: relation to treatment outcome in a multidisciplinary pain clinic. Cognit Ther Res 1992, 16:669–685.

    Article  Google Scholar 

  48. 48.

    Rosenstiel AK, Keefe FJ: The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 1983, 17:33–44.

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Keefe FJ, Crisson J, Urban BJ, Williams DA: Analyzing chronic low back pain: the relative contribution of pain-coping strategies. Pain 1990, 40:293–301.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Keefe FJ, Williams DA: A comparison of coping strategies in chronic pain patients in different age groups. J Gerontol 1990, 45:161–165.

    Google Scholar 

  51. 51.

    Cioffi D, Holloway J: Delayed costs of suppressed pain. J Pers Soc Psychol 1993, 64:274–282.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Goubert L, Crombez G, Eccleston C, Devulder J: Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain. Pain 2004, 110:220–227.

    PubMed  Article  Google Scholar 

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Johnson, M.H. How does distraction work in the management of pain?. Current Science Inc 9, 90–95 (2005). https://doi.org/10.1007/s11916-005-0044-1

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Keywords

  • Chronic Pain
  • Anterior Cingulate Cortex
  • Chronic Pain Patient
  • Distraction Task
  • Pain Sufferer