Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial

Lauren C. Heathcote, Konrad Jacobs, Dimitri M L Van Ryckeghem, Emma Fisher, Christopher Eccleston, Elaine Fox, Jennifer Y F Lau

Research output: Contribution to journalArticle

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Abstract

Attending toward and focusing on pain are central components in many psychological models of chronic pain [25,26,48,58,62]. In particular, an ‘attentional bias’ toward pain, the tendency to select pain-related information over non-pain information, is argued to increase the salience of pain, enhance fear and catastrophizing, motivate avoidance of painful activities, and increase disability. Given this crucial role, studies have begun to investigate whether pain-related attention biases can be modified and whether this modification impacts pain and pain-related outcomes. One tool for this purpose is Attention Bias Modification (ABM), a computerized training protocol that is proposed to train participants’ attention away from pain-related stimuli, possibly by altering top-down attention control [5,35].
ABM has been shown to increase cold pressor pain thresholds in healthy adults [3,43,54], and to significantly reduce pain intensity and frequency in adults with acute back pain [53]. In chronic pain samples, one uncontrolled study [52] and one placebo-controlled study [9] provided evidence that ABM decreases pain symptoms, although a third placebo-controlled study did not replicate these findings [53]. Studies with chronic pain samples have also provided evidence that ABM significantly reduces pain-related outcomes such as anxiety sensitivity [43,53], functional disability [53], and anxiety and depression symptoms [52]. Taken together, there is preliminary evidence that ABM may be efficacious for improving pain and pain-related outcomes, although findings across studies are mixed and additional, randomized-controlled trials are needed [59].
No studies have yet employed ABM for adolescents with chronic pain, despite previous findings that selective attention biases characterize paediatric patients with chronic pain [2,4] and that therapeutic techniques targeting attention, particularly attention control can moderate adolescents’ cognitive-affective response to pain as well as pain outcomes [33,34]. Strategies such as ABM that can encourage improvements in attention control ability – particularly at a developmental juncture when there are age-typical changes in mastery over attention [15,44] and associated maturation of brain regions engaged in goal-directed attention control [44,46,57] – may be especially beneficial. In addition, as chronic pain often first emerges in adolescence [47], investigating the plasticity and impact of pain-related attention during adolescence may allow consideration of its role in the early emergence and maintenance of chronic pain.
Here we report a three-arm randomized, placebo-controlled, parallel-group trial of multi-session ABM in adolescents with chronic non-cancer pain. We predicted that ABM, relative to placebo training and no training (waitlist), would significantly reduce attention bias to pain-related stimuli while also increasing attention control. We also expected that ABM would lead to relative improvements in pain symptoms and pain-related outcomes, namely pain catastrophizing, anxiety and depression symptoms, and functional disability. We examined effects of ABM on pain and pain-related outcomes immediately after training and three months later, to examine whether training effects maintained or emerged over time.
LanguageEnglish
Pages239-251
JournalPain
Volume159
Issue number2
Early online date29 Sep 2017
DOIs
StatusPublished - 1 Feb 2018

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Chronic Pain
Randomized Controlled Trials
Placebos
Pain
Catastrophization
Anxiety
Psychological Models
Depression
Pain Threshold
Aptitude
Acute Pain

Cite this

Heathcote, L. C., Jacobs, K., Van Ryckeghem, D. M. L., Fisher, E., Eccleston, C., Fox, E., & Lau, J. Y. F. (2018). Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial. DOI: 10.1097/j.pain.0000000000001084

Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial. / Heathcote, Lauren C.; Jacobs, Konrad; Van Ryckeghem, Dimitri M L; Fisher, Emma; Eccleston, Christopher; Fox, Elaine; Lau, Jennifer Y F.

In: Pain, Vol. 159, No. 2, 01.02.2018, p. 239-251.

Research output: Contribution to journalArticle

Heathcote, LC, Jacobs, K, Van Ryckeghem, DML, Fisher, E, Eccleston, C, Fox, E & Lau, JYF 2018, 'Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial' Pain, vol. 159, no. 2, pp. 239-251. DOI: 10.1097/j.pain.0000000000001084
Heathcote LC, Jacobs K, Van Ryckeghem DML, Fisher E, Eccleston C, Fox E et al. Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial. Pain. 2018 Feb 1;159(2):239-251. Available from, DOI: 10.1097/j.pain.0000000000001084
Heathcote, Lauren C. ; Jacobs, Konrad ; Van Ryckeghem, Dimitri M L ; Fisher, Emma ; Eccleston, Christopher ; Fox, Elaine ; Lau, Jennifer Y F. / Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial. In: Pain. 2018 ; Vol. 159, No. 2. pp. 239-251
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