The association between pain-related cognitive biases and their impact upon task interference by anticipating pain: a virtual reality approach

Abstract Contemporary pain theories postulate that pain-related attention bias (AB) and interpretation bias (IB) uniquely and synergistically impact upon poor pain outcomes. As yet, available research findings are scarce and mixed. The current study aimed to investigate the association between pain-related AB and IB and their impact upon task interference by impending pain. A total of 85 healthy participants performed a newly developed virtual reality (VR) paradigm allowing to simultaneously assess AB, IB, and pain-related task interference (ie, because of the presence of pain-related information) within a dynamic pain context. Particularly, participants learned to distinguish pain (CS+) from nonpain (CS−) cues, as represented by balls of varying blue shades. In a following test phase, participants completed a 2-back task while 1 of the 3 cue types (balls) was floating around in the VR environment: pain cues (CS+; light blue shades), ambiguous pain cues (CSA; mid blue shades), or nonpain cues (CS−; dark blue shades). During the entire paradigm, cue-related eye gaze (AB), pupillometry data and pain threat ratings (IB), as well as 2-back task performance (task interference) were recorded. Results indicated the presence of AB and IB for (ambiguous) pain cues. Furthermore, task interference (longer response latency) by pain-related information was observed in the presence of pain cues. In addition, results revealed a positive association between IB and AB toward identical ambiguous pain cues. Furthermore, AB and IB were found to uniquely, but not synergistically, impact upon task interference. Future validation studies replicating current findings while manipulating context features and goal pursuit are warranted.