Is distraction less effective when pain is threatening? An experimental investigation with the cold pressor task

Distraction is a commonly used strategy to control pain. However there is doubt about its effectiveness as a clinical tool, and results from both experimental and clinical studies remain inconclusive. Recent theoretical advancements suggest that distraction of attention may be less effective when pain is threatening. The aim of the present study was to experimentally investigate this hypothesis. Pain-free volunteers (N = 101) participated in a cold pressor test. Half of the participants simultaneously performed a cognitive distraction task, the other half did not. The threat value of the pain was manipulated by means of verbal information. The results showed that distraction resulted in less attention to the pain and lower pain ratings once the cold pressor procedure was halted. The hypothesis that the effectiveness of distraction is modulated by the threat value of pain could not be confirmed. However, threatening information increased catastrophic thoughts and anxiety, and interfered with performance on the distraction task. These findings suggest that caution is required in using distraction as a pain control strategy when the threat value is high, because fearful appraisal of pain is associated with less engagement in distraction tasks.