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The role of executive functioning in children's attentional pain control: An experimental analysis

Verhoeven, Katriena; Dick, Bruceb,c,*; Eccleston, Christopherd; Goubert, Liesbete; Crombez, Geerte

doi: 10.1016/j.pain.2013.11.002
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Summary Distraction as a process for managing pain is complex. While executive function may play a role in adult distraction, in this study it did not direct attention away from pain.

ABSTRACT Directing attention away from pain is often used in children's pain treatment programs to control pain. However, empirical evidence concerning its effectiveness is inconclusive. We therefore sought to understand other influencing factors, including executive function and its role in the pain experience. This study investigates the role of executive functioning in the effectiveness of distraction. School children (n = 164) completed executive functioning tasks (inhibition, switching, and working memory) and performed a cold-pressor task. One half of the children simultaneously performed a distracting tone-detection task; the other half did not. Results showed that participants in the distraction group were engaged in the distraction task and were reported to pay significantly less attention to pain than controls. Executive functioning influenced distraction task engagement. More specifically, participants with good inhibition and working memory abilities performed the distraction task better; participants with good switching abilities reported having paid more attention to the distraction task. Furthermore, distraction was found to be ineffective in reducing pain intensity and affect. Executive functioning did not influence the effectiveness of distraction. However, a relationship was found between executive functioning and pain affect, indicating that participants with good inhibition and working memory abilities experienced the cold-pressor task as less stressful and unpleasant. Our findings suggest that distraction as a process for managing pain is complex. While it appears that executive function may play a role in adult distraction, in this study it did not direct attention away from pain. It may instead be involved in the overall pain experience.

aKHLeuven Departement Gezondheidszorg en Technologie, Leuven 3000, Belgium

bDepartment of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada

cDepartment of Psychiatry, University of Alberta, Edmonton, AB, Canada

dCentre for Pain Research, University of Bath, Bath, UK

eDepartment of Experimental-Clinical and Health Psychology, Ghent University, Ghent 9000, Belgium

* Corresponding author at: Department of Anesthesiology and Pain Medicine, 8-120 Clinical Sciences Building, University of Alberta, Edmonton, AB T6G 2G3, Canada. Tel.: +1 780 407 1097; fax: +1 780 407 7461.

E-mail address:bruce.dick@ualberta.ca

Article history:

Received 10 August 2012

Received in revised form 14 October 2013

Accepted 4 November 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2014 International Association for the Study of Pain
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