Acceptance or distraction first while suffering acute pain? Order effects on visual attention to external painful stimuli.

introductionThis study examines attention to pain-related facial expressions in healthy individuals during a cold pain induction, as well as the efficacy of acceptance- or distraction-based instructions in modifying attentional patterns during the induction.

methodSixty pain-free participants completed an attentional task to analyse attentional biases towards pain-related facial expressions (Stage 1). Immediately afterwards, they performed a Cold Pressor Task (CPT) to obtain pain-related measures. Then, participants were randomly assigned to either an experimental group (n = 30), which performed the attentional task with cold water (acute pain condition), or a control group (n = 30), which performed the task with room-temperature water (Stage 2). Finally, both groups performed the same attentional task and were instructed to use two different coping strategies -acceptance and distraction-in a counterbalanced order under cold-pain conditions (Stage 3).

resultsAttentional biases to pain stimuli were found under pain-free conditions. The cold pain induction did not increase attention to pain-related stimuli; instead, it decreased attention to both pain and neutral stimuli. Regarding the efficacy of the guided coping strategies, acceptance followed by distraction (but not the reverse) significantly reduced attention to pain-related information. DISCUSSION: This study confirms the presence of attentional biases in pain-free individuals. However, the pain induction task reduced attention to both pain and neutral stimuli. More importantly, our study also showed that the order in which strategies are employed to cope with painful sensations is crucial for modifying attentional biases. This order effect might be a relevant mechanism that could inform future psychological interventions to treat pain. PERSPECTIVE: This study confirms that individuals without pain show attentional biases to pain-related information. In terms of coping strategies, we found a beneficial effect of using pain acceptance followed by distraction, not the other way around, to reduce attention to pain-related stimuli in an acute pain state. This finding of an order effect of coping strategies could be relevant for guiding psychological interventions on pain.