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Chronic pain is a major health problem across the globe. About 10-20% of the European population suffers from chronic pain of moderate to severe intensity, leading to reduced quality of life, inability to work, early retirement and tremendous societal and economic costs.
The health burden that chronic pain places on Europe will continue to grow because of an ageing population and an increase in health conditions associated with an increased prevalence of chronic pain, such as diabetes mellitus.
The EU-funded PainDynamics project investigated the role of a factor considered pivotal in initiating or exacerbating chronic pain: an individual’s attentional bias for pain information. This is a person’s tendency to selectively pay attention to pain-relevant information over other kinds of information. For a long time, this bias has been considered a stable and problematic factor.
‘We are amongst the first to stress that these attention biases are present in daily life because they are actually adaptive and can help us in many instances,’ says principal investigator Dimitri Van Ryckeghem, of Maastricht University in the Netherlands working under the co-ordinating institute, the University of Luxembourg.
‘Attention bias for pain-related information is, therefore, not a bad thing per se. In particular, we suggest that attention biases are actually driven by goals people pursue and we propose that it is inflexibility in the way people attend to pain information, irrespective of active goals or changing contexts, that results in people experiencing pain in a heightened way.’
Exploring pain in a real-life setting
Researchers in the PainDynamics project employed a range of new experimental methods and conceptual approaches that have contributed to a deeper understanding of how our attention patterns affect our perception of pain and its interference.
Their aim was to provide insight into how context affects pain, disability and distress and, in doing so, guide the use of existing treatments or develop new treatment options. Based on the reasoning that attention bias is dynamic, guided by goals and context – for example, one has to pick up children from school despite pain, or one aims to find a solution for pain – these goals should be taken into account when targeting and investigating cognitive biases.
Before the project, how we attend to pain information had generally been studied in the laboratory. Lab experiments, however, often fail to capture the reality of how goals, attention and pain fluctuate as individuals go about their daily lives. The PainDynamics project used specially designed equipment containing wearable vibrator pads delivering bodily sensations, to capture for the first time whether attention towards bodily sensations is influenced by the presence of pain in that location, in a daily life context.
‘We induced localised pain during daily life contexts by getting people to over-exercise so they felt stiff during the days after training. On these days, participants wore the vibrator pads to deliver vibrations of variable intensity, at different times to painful and non-painful body locations in an everyday setting,’ says Van Ryckeghem. ‘We compared the lowest level at which the vibrations could be experienced at painful and non-painful locations to see at which moments people are more attentive to sensations for the painful body part.’
Virtual reality as a tool to study pain
Another key conclusion the researchers drew is that attention towards pain is something that is highly variable according to context. ‘This contrasts with earlier accounts that assumed that selective attention towards pain is something that is stable. Based on our findings, we suggest that attention bias is not stable, i.e., not a trait, but varying from moment to moment depending on the goals we are pursuing,’ says Van Ryckeghem. ‘For example, if I am studying for an important exam, I will probably be less attentive to pain information, whereas, if I am really trying to control or get rid of my pain, I may be very focused on any pain information.’
The researchers behind the project plan to combine their research with virtual reality (VR) technology, to enable them to conduct lab experiments that more closely reflect pain in a daily life setting. This will allow researchers to investigate the impact of context more closely in a controlled yet realistic environment.
PainDynamics received funding from the EU’s Marie Skłodowska-Curie Actions programme and has led to several published papers, including in the journal Pain, the Scandinavian Journal of Pain, Clinical Psychology Review, Health Psychology Review and PloS One.