Exploring Attentional Bias for Real-World, Pain-related Information in Chronic Musculoskeletal Pain Using a Novel Change Detection Paradigm

Objectives: Attentional biases for pain-related words and images have commonly been reported in individuals with chronic pain. In former studies, however, pain-related stimuli have been presented without context, for example, facial expressions of pain with no accompanying information regarding the location, severity, or cause of pain or injury. The present study investigated attentional biases for pain-related information using complex, real-world scenes in an ecologically valid experimental paradigm. Methods: Participants with chronic musculoskeletal pain (n=20) and healthy, pain-free controls (n=23) completed a version of the change detection paradigm, the flicker task, which requires participants to detect a single difference between 2 otherwise identical versions of the same scene. These change-scenes were presented in a continuous cycle for approximately 3 minutes, with an unrelated distractor-scene interspersed between. Both pain-related and neutral scenes were used in 4 experimental conditions: change-pain/distractor-pain, change-pain/distractor-neutral, change-neutral/distractor-pain, and change-neutral/distractor-neutral. Results: Individuals with chronic musculoskeletal pain, relative to healthy control participants, took significantly longer to detect changes when the change-scene was pain-related. Within-group analysis showed healthy control participants to take significantly longer to detect changes in neutral change-scenes compared with pain-related change-scenes. Discussion: This study is the first to show individuals with chronic pain possess attentional biases for pain-related information presented as part of complex, real-world scenes. Possible future research includes the use of real-world scenes in visual-search paradigms modifying attentional biases, and exploration into the relations and effects of combined cognitive biases (eg, attention, memory, and interpretation) in chronic pain.