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Cognitive Biases Toward Pain

Implications for a Neurocognitive Processing Perspective in Chronic Pain and its Interaction With Depression

Rusu, Adina C., PhD*,†; Gajsar, Hannah, MSc*; Schlüter, Michael-Christian, MSc*; Bremer, Yara-Inken, MSc*

doi: 10.1097/AJP.0000000000000674
Review Articles

Objectives: Information-processing biases such as attentional, interpretation, and memory biases are supposed to play a role in the exacerbation and maintenance of chronic pain. Current research in the area of cognitive biases shows that all these biases seem to have an influence on attention to, interpretation of, and recall of pain and can lead to maladaptive strategies and the exacerbation of pain.

Methods: We conducted a narrative literature review, considering evidence extracted from various databases including PubMed, MEDLINE, Science Direct, and ProQuest. Search terms included cognitive biases, neurocognitive processing, chronic pain, and depression.

Results: The literature on attentional, interpretative, and memory biases in experimental and chronic pain, as well as their neuronal underpinnings, suggests that the depression of chronic pain patients may differ from the depression of patients without pain. Depressed pain patients show a recall bias for illness-related and health-related stimuli, whereas depressed patients without pain show a bias for depression-related stimuli. In addition, research has shown that catastrophizing, helplessness/hopelessness, and thought suppression as psychological responses to pain are mediators of the relationship between chronic pain and depression.

Conclusions: Current research supports the importance of individual diagnosis of chronic pain patients and their response patterns of pain, psychological processing, and information processing. This leads to the conclusion that depressed pain patients need other clinical interventions when compared with depressed patients without pain. Previous research showed that a combination of a cognitive-behavioral therapy with mindfulness meditation seems to be a promising approach.

*Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Germany

Department of Psychology, Royal Holloway University of London, Egham, UK

The contribution of A.C.R. was supported by a grant from FORUM (AZ: F819-14), the Research Committee of the Medical Faculty, University of Bochum, Germany. The authors declare no conflict of interest.

Reprints: Adina C. Rusu, PhD, Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitaetsstr. 150, MA 0/141, Bochum 44780, Germany (e-mail:

Received April 28, 2018

Received in revised form November 5, 2018

Accepted November 14, 2018

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