Attentional bias towards pain-related information diminishes the efficacy of distraction

Distraction is a strategy that is commonly used to cope with pain. Results concerning the efficacy of distraction from both experimental and clinical studies are variable, however, and indicate that its efficacy may depend on particular circumstances. Several models propose that distraction may be less effective for people who display a large attentional bias towards pain-related information. This hypothesis was tested in an experimental context with 53 pain-free volunteers. First, attentional bias towards cues signalling the occurrence of pain (electrocutaneous stimuli) and towards words describing the sensory experience of this painful stimulus was independently assessed by means of 2 behavioural paradigms (respectively, spatial cueing task and dot-probe task). This was followed by a subsequent distraction task during which the efficacy of distraction, by directing attention away from the electrocutaneous stimuli, was tested. In addition, state-trait anxiety, catastrophic thinking, and initial pain intensity were measured. Results indicated that people who display a large attentional bias towards predictive cues of pain or who initially experience the pain as more painful benefit less from distraction on a subsequent test. No effects were found between attentional bias towards pain words, state-trait anxiety, catastrophic thinking, and the efficacy of distraction. Current findings suggest that distraction should not be used as a 'one size fits all' method to control pain, but only under more specific conditions

Goal pursuit in individuals with chronic pain: a personal project analysis

Objectives: In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., "to control my pain") and non-pain goals (e.g., "to go to work"). Design and Methods: "Personal Project Analysis" was used in 73 ICPs (48 females; 25 males; M-age = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed. Results: Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly. ICP's with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing. Discussion: An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental

The relation between goal adjustment, goal disturbance, and mental well-being among persons with multiple sclerosis

Objective: This study investigated the role of goal adjustment, i.e. disengaging from blocked goals and reengaging into alternative goals, in mental well-being and goal disturbance in persons with multiple sclerosis (MS). Design: A cross-sectional design was used with self-report data from questionnaires and Personal Project Analysis (PPA). Main outcome measures: Dependent variables were mental well-being, indicated by depression/anxiety (HADS; Hospital Anxiety and Depression Scale) and mental functioning (SF-36; Short Form Health Survey), and goal disturbance, indicated by goal manageability and goal interference (PPA). Independent variables were patient-reported physical impairment (SF-36) and goal disengagement and reengagement (GAS; Goal Adjustment Scale). Results: Higher goal reengagement was associated with better mental well-being, but unrelated to goal disturbance. Goal disengagement only showed a negative association with anxiety. High disengagement was associated with lower goal interference but only for those also scoring high on reengagement. Goal adjustment did not buffer the effects of physical impairment on mental well-being and goal disturbance. Contrary to expectations, higher goal reengagement increased the association between physical impairment and goal interference. Conclusion: Although goal reengagement is associated with better mental well-being in persons with MS, it might also strengthen the perceived effect of physical impairment on goal interference

Signals of threat do not capture, but prioritize, attention: a conditioning approach

Research suggests that threatening information captures attention more rapidly than neutral information. However, in most studies threat stimuli differ perceptually from neutral stimuli and are instrumental to perform the task, leaving the question unanswered whether threat is sufficient to capture attention. In experiment 1, we designed a visual search task with stimuli of equal salience (colored circles) that have the potential to lead to efficient search (10 ms/item). In experiment 2, one of the colors (conditioned stimulus, CS+) was made threatening by means of fear conditioning. Participants responded to a target presented in one of the circles. Overall, the search was faster on congruent trials (where the target was presented in the CS+) than on baseline trials (where the CS + was absent). Furthermore, the search was slower on incongruent trials (where the target was presented in another color than the CS+) than on baseline trials. The search on congruent trials was affected by set size (90 ms/item), but to a lesser extent than on baseline trials (105 ms/item). We conclude that threat prioritizes, but does not capture attention

A catalytically active membrane reactor for fast, exothermic, heterogeneously catalysed reactions

A membrane reactor with separated feed of reactants is demonstrated as a promising contractor type when dealing with heterogenously catalysed, very fast and exothermic gas phase reactions. Due to the separation of reactants a good control of the system is obtained, because process variables can be varied independently from each other. Transport of reactants is the rate governing process and because this is only slightly temperature dependent a thermal runaway will not occur. When dealing with e.g. combustion process no explosive mixtures will build up and safety is increased. Based on the dusty-gas model, the concentration profiles of components inside the membrane can be calculated together with the fluxes. However this is a calculation time consuming process and not necessary in all cases. In absence of a pressure drop and no slip of reactants to the opposite side a linearisation is possible leading to a simplified expression for the interfacial flux of a reactant and a criterion to evaluate the possibility of slip of reactants. Using the oxidation of carbon monoxide catalysed by platinum as a model reaction this approximation was experimentally verified by comparison of measured fluxes with the calculated results. Apart from flux measurements exploratory overall conversion measurements were carried out with the membrane reactor module in order to demonstrate its operation performance. From these studies it was concluded that conversion levels up to 90% carbon monoxide could easily be achieved

Fear-avoidance model of chronic pain the next generation

Objective: The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. Methods: A narrative review. Results: There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. Discussion: To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals

To control or not? A motivational perspective on coping with pain

Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists