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The Journal of Pain, Vol 7, No 1 (January), 2006: pp 21-22Available online at www.sciencedirect.com

COMMENTARY

he Interruptive Effect of Pain on Attention

inda M. G. Vancleef and Madelon L. Petersepartment of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht,

he Netherlands.

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large body of research has been conducted to studythe relationship between pain and attention. It hasbeen suggested that focusing attention on the per-

ormance of a high attention-demanding task can serve ascognitive coping strategy to deal with pain, because all

ttentional resources will be devoted to task performance.n the other hand, evidence exists that pain can automat-

cally enter focal attention, even when attention is beingevoted to the performance of an attention-demandingask. Eccleston8 found that patients with high levels of self-eported pain performed worse on an attention-demand-ng task than those reporting lower pain levels, evenhough they were instructed to ignore their pain and focusn task performance.When trying to explain the disturbing effect of pain on

ttention, it is important to consider the parameters thatnfluence this effect. Several studies have used the pri-

ary task paradigm in their search for these parametersnd revealed that besides the pain intensity, the novelty,npredictability, and threat value of pain stimuli enlargettentional disruption by pain.1-4,9,10 Thus, attentionalnterference by pain is larger when the pain stimulus isew and unfamiliar to the individual, or when the paintimulus holds an implicit or explicit threat. But not onlyualities of the pain stimulus itself determine the degree

n which pain will interrupt attention. Individual charac-eristics may also moderate the attentional interferenceffect. Research found that persons who interpret pains threatening, and persons who tend to catastrophizen the possible meaning and consequences of pain show

n enhanced disruptive effect on attention.5,6,9,10 s

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ddress reprint requests to Linda Vancleef, Department of Medical,linical and Experimental Psychology, Maastricht University, P.O. Box16, 6200 MD Maastricht, The Netherlands. E-mail: L.Vancleef@mkep.unimaas.nl526-5900/$32.002006 by the American Pain Society

oi:10.1016/j.jpain.2005.11.003

We conclude that pain does interrupt attention, buthat its intrusion into focal awareness is dependent uponeveral characteristics of the pain stimulus and the mean-ng that is assigned to it. The apparent contradictive out-omes of the study by Veldhuijzen et al12 and our study11

hould be interpreted in this light. We made use of anlectrical pain stimulus of short duration that we admin-stered randomly at several times during task perfor-

ance. The imminent threat value of the pain stimulusas manipulated through instruction. Veldhuijzen et alsed a more tonic pain stimulus (ie, cold pressor pain)hat was continuously present during task performance.revious studies, as well as or own study show that inter-uption by pain on attention is largest immediately afterain onset, after which the interruptive effect diminishesuickly.2-4,11 Immediately upon pain onset, an automaticrienting reflex occurs in which attention is devoted tohe pain, and a fast evaluation of the meaning and grav-ty of the pain is made. When the result of this evaluationeveals that the pain is not threatening, attention will beevoted again to the task and performance will no

onger suffer.In the study of Veldhuijzen et al, the pain stimulus mayave lost its meaningfulness to the participants owing to

ts long duration, making it easier to distract from. Fur-hermore, Veldhuijzen et al did not include measures ofndividual variability between participants. We believehat both our study and previous studies demonstratehat attentional interference was enhanced in personsith high levels of pain catastrophizing, fear of pain, or

omatic awareness.5-7,10,11

eferences

. Crombez G, Baeyens F, Eelen P: Sensory and temporalnformation about impending pain: The influence of pre-ictability on pain. Behav Res Ther 32:611-622, 1994

. Crombez G, Eccleston C, Baeyens F, Eelen P: The disrup-ive nature of pain: An experimental investigation. Behav

es Ther 34:911-918, 1996

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. Crombez G, Eccleston C, Baeyens F, Eelen P: Habituationnd the interference of pain with task performance. Pain0:149-154, 1997

. Crombez G, Eccleston C, Baeyens F, Eelen P: Attentionalisruption is enhanced by the threat of pain. Behav Res Ther6:195-204, 1998

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1. Vancleef LMG, Peters ML: Pain catastrophizing, but notnjury/illness sensitivity or anxiety sensitivity, enhances at-entional disruption by pain. J Pain 7:23-30, 2006

2. Veldhuijzen DS, Kenemans JL, Bruin de M, Olivier B,olkerts ER: Pain and attention: Attentional disruption or

istraction? J Pain 7:11-20, 2006