The role of threat-expectancy in acute pain: effects on attentional bias, coping strategy effectiveness and response to pain

The aims of this study were threefold. Firstly, to investigate the effect of increasing threat-expectancy on attentional biases towards pain-related words. Secondly, to determine the interaction between threat-expectancy and the effectiveness of two coping strategies on pain threshold and tolerance. Thirdly, to investigate the relationship between fear of pain and the experimental manipulations. One hundred undergraduate psychology students were randomly assigned to receive either threat-increasing or reassuring information about the cold pressor task. After reading the information, all participants completed the dot-probe task for four categories of pain-related words. Following the dot-probe task, participants were randomly allocated to one of two coping strategy conditions (focusing on affective vs sensory aspects of pain). Participants then completed the cold pressor task while engaging in the relevant coping strategy. There was a significant effect of threat on bias towards affective vs sensory pain words. Participants in the threat condition showed a stronger bias towards affective pain words. In contrast, the no-threat condition displayed a stronger bias towards sensory pain words. Significant interaction effects were observed between threat and coping strategy for threshold and tolerance. These results indicated that focusing on sensory pain sensations was helpful in the absence of threat, however, in the presence of threat was relatively unhelpful in comparison to focusing on the affective components of pain. The present results provide support for the fear-avoidance model of pain [Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317-332] and confirm the importance of threat-expectancy in hypervigilance towards pain and fear avoidance.