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Attentional Avoidance is Associated with Increased Pain Sensitivity in Patients with Chronic Posttraumatic Pain and Comorbid Posttraumatic Stress.

Harvold, Mathea; MacLeod, Colin PhD; Vaegter, Henrik Bjarke PhD
Clinical Journal of Pain: Post Acceptance: April 7, 2017
doi: 10.1097/AJP.0000000000000505
Original Article: PDF Only

Objectives: Posttraumatic stress disorder (PTSD) is common in chronic posttraumatic pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic pain and PTSD, however, the influence of AB on clinical and heat pain sensitivity in chronic posttraumatic pain patients is unknown. This study investigated AB for linguistic pain- and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD.

Methods: Thirty-four patients with chronic posttraumatic cervical pain performed the visual attentional probe task assessing patterns of selective attentional responding to trauma cues and to pain cues. The task used short (500 ms) and long (1250 ms) stimulus exposure durations to ensure sensitivity to both the orienting and maintenance of attention. Heat pain threshold (HPT) was assessed at the non-painful hand. Clinical pain intensity, psychological distress (anxiety, depression, and disability), and PTSD symptomatology were assessed with questionnaires.

Results: The Pain/PTSD group (N=14) demonstrated increased clinical and heat pain sensitivity as well as psychological distress compared with the Pain/No-PTSD group (N=20; P<0.05). AB scores were significantly different between groups (P=0.04). Irrespective of stimulus exposure duration, the Pain/PTSD group demonstrated attentional bias away from trauma and pain cues (avoidance) whereas the Pain/No PTSD group demonstrated attentional bias towards pain cues (vigilance). Attentional avoidance of pain cues was associated with increased pain intensity and heat pain sensitivity (P<0.02).

Discussion: These results suggest that attentional avoidance is associated with increased chronic posttraumatic pain. The causal contribution of attentional avoidance to pain outcomes remains unclear.

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