The impact of maternal child- and self-oriented pain-related injustice appraisals upon maternal attention to child pain, attention to anger, and pain-attending behavior

in British Journal of Pain (2021)

Objectives The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and ... [more ▼]

Objectives The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and pain-attending behavior. Methods Forty-four children underwent a painful cold pressor task (CPT) while their mother observed. Eye tracking was used to measure maternal attention to child pain and adult anger cues. Initial attention allocation and attentional maintenance were indexed by probability of first fixation and gaze duration, respectively. Maternal pain-attending behaviors toward the child were videotaped and coded after CPT completion. Mothers also rated the intensity of pain and anger cues used in the free-viewing tasks. All analyses controlled for maternal catastrophizing about child pain. Results Neither child-oriented nor self-oriented injustice was associated with maternal attentional bias toward child pain. Regarding attention toward self-relevant anger cues, differential associations were observed for self- and child-oriented injustice appraisals, with maternal self-oriented injustice being associated with a greater probability of first fixating on anger and with higher anger ratings, whereas maternal child-oriented injustice was associated with enhanced attentional maintenance toward anger. Neither type of maternal injustice appraisals was associated with maternal pain-attending behavior, which was only associated with maternal catastrophizing. Conclusions The current study sheds light on potential differential mechanisms through which maternal self- vs. child-oriented injustice appraisals may exert their impact on parent and child pain-related outcomes. Theoretical implications and future directions are discussed. [less ▲]

Racial disparities in observers' attention to and estimations of others' pain

in Pain (2021)

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such ... [more ▼]

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such disparities. The present study had 2 aims. First, we examined whether White observers' attentional processing of pain (using a visual search task [VST] indexing attentional engagement to and attentional disengagement from pain) and estimation of pain experience differed between White vs Black faces. Second, we examined whether these differences were moderated by (1) racially biased beliefs about pain experience and (2) the level of pain expressed by Black vs White faces. Participants consisted of 102 observers (87 females) who performed a VST assessing pain-related attention to White vs Black avatar pain faces. Participants also reported on racially biased beliefs about White vs Black individuals' pain experience and rated the pain intensities expressed by White and Black avatar faces. Results indicated facilitated attentional engagement towards Black (vs White) pain faces. Furthermore, observers who more strongly endorsed the belief that White individuals experience pain more easily than Black individuals had less difficulty disengaging from Black (vs White) pain faces. Regarding pain estimations, observers gave higher pain ratings to Black (vs White) faces expressing high pain and White (vs Black) faces expressing no pain. The current findings attest to the importance of future research into the role of observer attentional processing of sufferers' pain in understanding racial disparities in pain care. Theoretical and clinical implications are discussed, and future research directions are outlined. [less ▲]

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study

in European Journal of Pain (2021), 25(10), 2094-2111

Background: Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of ... [more ▼]

Background: Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce. Methods: This study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e. experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children's demographic (i.e. sex and age) and psychological (i.e. baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (Mage = 11.85, SD = 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e. experimental group) or to a control condition whereby they did not watch any video. Results: Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison with the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only. Conclusions: Further investigation is needed to optimize pain educational video interventions and to determine whether more beneficial outcomes can be found in clinical (i.e. non-experimental) situations and in children with persistent or recurring pain problems. Significance: Examining the impact of pain educational interventions within a non-clinical setting is deemed particularly important given that adaptive pain coping strategies likely play an important role in preventing the development and maintenance of future maladaptive pain-related behaviour. Further, study findings provide preliminary evidence of baseline and demographic (i.e. age and sex) characteristics explaining differences in the effect of a pain educational video intervention in pain knowledge and pain-related experiences during experimental pain. [less ▲]

Attentional biases in pediatric chronic pain : an eye-tracking study assessing the nature of the bias and its relation to attentional control

in PAIN (2020), 161(10), 2263--2273

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings, and few studies have ... [more ▼]

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings, and few studies have examined attentional biases in pediatric samples. This study used eye-gaze tracking to examine attentional biases to pain-related stimuli in a clinical sample of youth with chronic pain and pain-free controls. The moderating role of attentional control was also examined. Youth with chronic pain (n = 102) and pain-free controls (n = 53) viewed images of children depicting varying levels of pain expressiveness paired with neutral faces while their eye gaze was recorded. Attentional control was assessed using both a questionnaire and a behavioural task. Both groups were more likely to first fixate on high pain faces but showed no such orienting bias for moderate or low pain faces. Youth with chronic pain fixated longer on all pain faces than neutral faces, whereas youth in the control group exhibited a total fixation bias only for high and moderate pain faces. Attentional control did not moderate attentional biases between or within groups. The results lend support to theoretical models positing the presence of attentional biases in youth with chronic pain. Further research is required to clarify the nature of attentional biases and their relationship to clinical outcomes. [less ▲]

Parental emotion and pain control behaviour when faced with child’s pain : the emotion regulatory role of parental pain-related attention-set shifting and heart rate variability

in PAIN (2019), 160(2), 322--333

Parental emotion and pain control behaviour when faced with child’s pain: the emotion regulatory role of parental pain-related attention-set shifting and heart rate variability

in Pain (2018)

, The present study investigated the moderating role of parental pain-related attention-set shifting and heart rate variability (HRV) for parental distress and pain control behaviour when faced with their ... [more ▼]

, The present study investigated the moderating role of parental pain-related attention-set shifting and heart rate variability (HRV) for parental distress and pain control behaviour when faced with their child’s pain. Participants were 54 school children and one of their parents. Parental HRV was assessed at study commencement followed by a cued switching task indexing parental ability to flexibly shift attention between pain-related and neutral attentional sets. In a subsequent phase, parents observed their child perform a CPT task, allowing assessment of parental pain control behavior (indexed by latency to stop their child’s CPT performance) and parental distress – assessed via self-report following observation of child CPT performance. Findings indicated that parental facilitated attentional shifting (i.e., engage) towards a pain-related attentional set contributed to higher levels of pain control behaviour when faced with increasing levels of chid facial display of pain. Pain control behaviour amongst parents who demonstrated impeded attentional shifting to a pain-related attentional set was equally pronounced regardless of low or high levels of child pain expression. Parental ability to shift attention away (i.e., disengage) from a pain related set to a neutral set did not impact findings. Results further indicated that whereas high levels of parental HRV buffers the impact of child facial pain display upon parental emotional distress and pain control behaviour, low levels of HRV constitute a risk factor for higher levels of parental distress and pain control behaviour when faced with increased child facial pain display. Theoretical/clinical implications and further research directions are discussed. [less ▲]

The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample.

in Journal of Pain (2016), 17(11), 1207-1216

The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and ... [more ▼]

The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and difficulty of a standardized set of common physical activities. A pictorial dot-probe task assessed AB toward pain stimuli (ie, pain faces cueing pain), after which participants performed the physical tasks. Participants also rated face stimuli in terms of pain, sadness, and anger expression. As hypothesized, perceived injustice was positively associated with AB toward pain stimuli; additionally, perceived injustice and AB were positively associated with appraisals of pain and difficulty. Counter to expectations, AB did not mediate the relationship between perceived injustice and task appraisals, suggesting that AB is insufficient to explain this relationship. Exploratory analyses indicated that participants with higher levels of perceived injustice rated stimulus faces as sadder and angrier; no such differences emerged for pain ratings. To our knowledge, this is the first study to examine the association between perceived injustice and AB toward pain, as well as perceived injustice and in vivo appraisals of common physical activity. Results extend existing literature and suggest that attentional and potential interpretive bias should be considered in future research. PERSPECTIVE: This article identifies significant associations between perceived injustice, biased attention to pain, and appraisals of common physical activities among individuals with chronic low back pain. These findings suggest targets for intervention as well as directions for future research regarding individuals with high perceptions of injustice related to pain. [less ▲]

Children's selective attention to pain and avoidance behaviour: the role of child and parental catastrophizing about pain.

in Pain (2013), 154(10), 1979-88

The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing ... [more ▼]

The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing about pain (ie, rumination, magnification, and helplessness). Participants were 59 children (31 boys) aged 10-16 years and one of their parents (41 mothers). Children performed a dot-probe task in which child facial pain displays of varying pain expressiveness were presented. Child avoidance behaviour was indexed by child pain tolerance during a cold-pressor task. Children and parents completed measures of child and parent pain catastrophizing, respectively. Findings indicated that both the nature of child selective attention to pain and the impact of selective attention upon child avoidance behaviour were differentially sensitive to specific dimensions of child and parental catastrophizing. Specifically, findings showed greater tendency to shift attention away from pain faces (i.e.,, attentional avoidance) among children reporting greater pain magnification. A similar pattern was observed in terms of parental characteristics, such that children increasingly shifted attention away from pain with increasing levels of parental rumination and helplessness. Furthermore, child attentional avoidance was associated with greater avoidance behaviour (i.e., lower pain tolerance) among children reporting high levels of pain magnification and those whose parents reported greater rumination about pain. The current findings corroborate catastrophizing as a multidimensional construct that may differentially impact outcomes and attest to the importance of assessing both child and parental characteristics in relation to child pain-related attention and avoidance behaviour. Further research directions are discussed. [less ▲]