Distraction and the processing of pain : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

Abstract

Distraction is useful for increasing pain thresholds and tolerances and reducing ratings of acute pain and is often incorporated in pain management programmes for chronic pain. However, its usefulness for chronic pain management is questionable. Rosenstiel and Keefe (1983) and Turner and Clancy (1986) both found that chronic pain patients who scored high on the Diverting Attention and Praying factor of the Coping Strategies Questionnaire also had high average pain.

The aim of the present study was to evaluate the utility of distraction for 8 male and 12 female chronic low back pain subjects in acute and chronic pain conditions. It was hypothesised that for the chronic pain condition distraction would not be effective in reducing pain ratings or increasing pain tolerances as the chronic pain perception has over time, come to be automatically processed. Under such circumstances distraction would not be effective as there would be no competition with pain processing for the limited attentional resources. Distraction however, would be effective in reducing acute pain as acute pain is of short duration and likely to be a controlled process. By implication, the third hypothesis proposed that chronic pain and acute pain are processed differently by chronic pain sufferers with the utility of distraction differing accordingly.

Subjects did the cold presser test for the acute pain conditions, and a step-up exercise for the chronic pain conditions. These conditions were done with and without a shadowing distraction task. A post-test questionnaire was completed at the end of the study. Pain measures were pain ratings, pain tolerances, and also the number of step­ ups for the chronic pain conditions.

Results showed that no effect of distraction on pain tolerances and post-test pain ratings. Not only was distraction found ineffective for chronic pain as hypothesised, but it was also ineffective for acute pain management. There was no interaction effect of distraction with acute/chronic pain to support the third hypothesis. Pain ratings and pain tolerances were significantly different between pain conditions.

Automatic processes are generally not effected by simultaneous controlled processes. The results from this study suggest that chronic pain may have developed over time into an automatic process as the distraction task had no effect on the pain measures, and there was no loss in accuracy on the distraction task across the chronic pain condition. Acute pain however should not have developed into an automatic process as it is of short duration and variably mapped. The ineffectiveness of distraction in dealing with acute pain suggests that maybe the subjects have become hypervigilant to all pain sensations, or that distraction loses its effectiveness over time.

The outcome of this study highlights the need to both determine the active components of cognitive strategies for chronic pain management and to investigate further the processing of chronic pain.