Controlling attention to nociceptive stimuli with working memory

Background: Because pain often signals the occurrence of potential tissue damage, a nociceptive stimulus has the capacity to involuntarily capture attention and take priority over other sensory inputs. Whether distraction by nociception actually occurs may depend upon the cognitive characteristics of the ongoing activities. The present study tested the role of working memory in controlling the attentional capture by nociception. Methodology and Principal Findings: Participants performed visual discrimination and matching tasks in which visual targets were shortly preceded by a tactile distracter. The two tasks were chosen because of the different effects the involvement of working memory produces on performance, in order to dissociate the specific role of working memory in the control of attention from the effect of general resource demands. Occasionally (i.e. 17% of the trials), tactile distracters were replaced by a novel nociceptive stimulus in order to distract participants from the visual tasks. Indeed, in the control conditions (no working memory), reaction times to visual targets were increased when the target was preceded by a novel nociceptive distracter as compared to the target preceded by a frequent tactile distracter, suggesting attentional capture by the novel nociceptive stimulus. However, when the task required an active rehearsal of the visual target in working memory, the novel nociceptive stimulus no longer induced a lengthening of reaction times to visual targets, indicating a reduction of the distraction produced by the novel nociceptive stimulus. This effect was independent of the overall task demands. Conclusion and Significance: Loading working memory with pain-unrelated information may reduce the ability of nociceptive input to involuntarily capture attention, and shields cognitive processing from nociceptive distraction. An efficient control of attention over pain is best guaranteed by the ability to maintain active goal priorities during achievement of cognitive activities and to keep pain-related information out of task settings

Vicarious experiences and detection accuracy while observing pain and touch: the effect of perspective taking

In this study, we investigated the effects of observing pain and touch in others on vicarious somatosensory experiences and the detection of subtle somatosensory stimuli. Furthermore, the effect of taking a first- versus a third-person perspective was investigated. Undergraduates (N = 57) viewed videos depicting hands being pricked (pain), hands being touched by a cotton swab (touch), and control scenes (same approaching movement of a hand as in the other video categories, but without the painful/touching object) while experiencing vibrotactile stimuli themselves on the left, on the right, or on both hands. Participants reported the location at which they felt a somatosensory stimulus. The vibrotactile stimuli and visual scenes were applied in a spatially congruent or incongruent way, and other trials were presented without vibrotactile stimuli. The videos were depicted in first-person perspective and third-person perspective (i.e., the videos were shown upside down). We calculated the proportions of correct responses and false alarms (i.e., numbers of trials on which a vicarious somatosensory experience was reported congruent or incongruent to the site of the visual information). Pain-related scenes facilitated the detection of tactile stimuli and augmented the number of vicarious somatosensory experiences, as compared with observing the touch or control videos. Detection accuracy was higher for videos depicted in first-person perspective than for those in third-person perspective. Perspective had no effect on the number of vicarious somatosensory experiences. This study indicates that somatosensory detection is particularly enhanced during the observation of pain-related scenes, as compared to the observation of touch or control videos. These research findings further demonstrate that perspective taking impacts somatosensory detection, but not the report of vicarious experiences

Observing another in pain facilitates vicarious experiences and modulates somatosensory experiences

Objective: This study investigated whether individuals reporting vicarious pain in daily life (e.g., the self-reported vicarious pain group) display vicarious experiences during an experimental paradigm, and also show an improved detection of somatosensory stimuli while observing another in pain. Furthermore, this study investigated the stability of these phenomena. Finally, this study explored the putative modulating role of dispositional empathy and hypervigilance for pain. Methods: Vicarious pain responders (i.e., reporting vicarious pain in daily life; N = 16) and controls (N = 19) were selected from a large sample, and viewed videos depicting pain-related (hands being pricked) and non-pain related scenes, whilst occasionally experiencing vibrotactile stimuli themselves on the left, right or both hands. Participants reported the location at which they felt a somatosensory stimulus. We calculated the number of vicarious errors (i.e., the number of trials in which an illusionary sensation was reported while observing pain-related scenes) and detection accuracy. Thirty-three participants (94.29%) took part in the same experiment 5 months later to investigate the temporal stability of the outcomes. Results: The vicarious pain group reported more vicarious errors compared with controls and this effect proved to be stable over time. Detection was facilitated while observing pain-related scenes compared with non-pain related scenes. Observers' characteristics, i.e., dispositional empathy and hypervigilance for pain, did not modulate the effects. Conclusion: Observing pain facilitates the detection of tactile stimuli, both in vicarious pain responders and controls. Interestingly, vicarious pain responders reported more vicarious errors during the experimental paradigm compared to controls and this effect remained stable over time

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

Advancing psychological therapies for chronic pain

There is a strong tradition of therapy development and evaluation in the field of psychological interventions for chronic pain. However, despite this research production, the effects of treatments remain uncertain, and treatment development has stalled. This review summarises the current evidence but focusses on promising areas for improvement. Advancing psychological therapies for chronic pain will come from a radical re-imagining of the content, delivery, place, and control of therapy. The next generation of therapeutic interventions will also need alternative methods of measurement and evaluation, and options are discussed