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

Harvold, Mathea MSc*; MacLeod, Colin PhD; Vaegter, Henrik B. PhD‡,§

doi: 10.1097/AJP.0000000000000505
Original Articles

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-related stimuli and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD.

Materials and Methods: In total, 34 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 was assessed at the nonpainful 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 toward 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.

Supplemental Digital Content is available in the text.

*Department of Psychology, Faculty of Health Sciences

§Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark

Pain Research Group, Pain Centre South, Odense University Hospital, Odense, Denmark

School of Psychology, The University of Western Australia, Crawley, Australia

The authors declare no conflict of interest.

Reprints: Henrik B. Vaegter, PhD, Pain Research Group, Pain Center South, University Hospital Odense, Heden 7-9, entrance 200, 5000 Odense C, Denmark (e-mail:

Received October 20, 2016

Received in revised form March 24, 2017

Accepted April 1, 2017

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