Gaining insights on the influence of attention, anxiety, and anticipation on pain perception

Abstract

Purpose: This article highlights the influence of attention and pain anticipation on pain attenuation. Pain-related trait anxiety was found to moderate the effect that attention strategies impose on pain perception. This article may contribute to clinical treatments quality, where pain attenuation effect is desired.

Participants and methods: One hundred seven participants, comprising of 72 (67%) females and 35 (33%) males between the age of 17 and 48 (M=22.6, SD =4.36), were used in the analysis. The current study measured the effect of pain anticipation and attention on three aspects of pain perception: threshold, tolerance, and perceived pain intensity. Pain anticipation was manipulated by varying the amount of information given to participants about a future pain stimulus. Attention was manipulated through a sensory focusing task and a distraction task. Participants were randomized into 1) InfoControl group with distraction task trial (n=30), 2) InfoControl group with attention to pain trial (n=26), 3) InfoExtra group with distraction task trial (n=26), or 4) InfoExtra group with attention to pain trial (n=25). The pain stimulus was delivered in a form of heat. The moderating effects of pain-related trait anxiety on these variables were also investigated using Pain Anxiety Symptom Scale Short Form.

Results: Two structural equation models revealed that anticipation is not a predictor of pain perception and neither did it interact with pain-related trait anxiety. However, attention strategies do significantly relate to pain perception. Furthermore, pain-related anxiety was a significant moderator of attention and pain attenuation. These findings imply that the effectiveness of attention strategies in attenuating pain is affected by individuals' pain-related trait anxiety.

Conclusion: The results suggest the importance of appointing the appropriate attention strategy to different individuals with varying level of trait anxiety. Future explorations are necessary to develop a more specific understanding on the nature of information and distractions on pain perception.

Keywords: distractions; pain attenuation; sensory focusing; trait anxiety.

Figure 1

Summary of PCP. Notes: This figure depicts the flow of PCP in Phase 3, after participants have undergone information manipulation. The single-headed arrow (→) denotes the sequence of the procedure from one step to another. T_B indicates baseline temperature, at which participants reported feeling uncomfortable. Abbreviation: PCP, pain calibration procedure.

Figure 2

Predicted anticipation model. Notes: This figure depicts the structural equation modeling used to analyze the influence of pain anticipation, pain-related anxiety, and the moderating effect of pain-related anxiety on pain perception. The rectangles () represent observed variables, while the ellipses () represent the unobserved latent factors. The single-headed arrows with solid lines (→) represent the path coefficient for regression of one variable on another. The double-headed arrows (↔) represent covariances or correlations between pairs of variables. Trait anxiety indicates pain-related trait anxiety. “×” in Anticipation × Trait anxiety box indicates the interaction between anticipation and pain-related trait anxiety. e1 indicates measurement error for pain threshold reading; e2 indicates measurement error for pain tolerance reading; e3 indicates measurement error for perceived pain intensity rating.

Figure 3

Predicted attention model. Notes: This figure depicts the structural equation modeling used to analyze the influence of attention strategies, pain-related anxiety, and the moderating effect of pain-related anxiety on the change in pain perception. The rectangles ([img]) represent observed variables, while the ellipses ([img]) represent the unobserved latent factors. The single-headed arrows with solid lines (→) represent the path coefficient for regression of one variable on another. The double-headed arrows (↔) represent covariances or correlations between pairs of variables. Trait anxiety indicates pain-related trait anxiety. “×” in Strategy × Trait anxiety box indicates the interaction between attention strategy and pain-related trait anxiety. e1 indicates measurement error for the change in pain threshold reading; e2 indicates measurement error for the change in pain tolerance reading; e3 indicates measurement error for the change in perceived pain intensity rating.

Figure 4

Interaction between attention task and pain-related trait anxiety. Notes: The change in pain perception was measured as final – initial rating of the respective pain perception ratings. Participants in attention group (n=51) were told to pay attention to and verbalize the heat sensation that they felt on their palm. Participants in the distraction group (n=55) were told to engage in a game presented on a computer in front of them.