title: Distraction analgesia in chronic pain patients: the impact of catastrophizing.
abstract: BACKGROUND
  Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction.
  
  
  METHODS
  Chronic pain patients (n=149) underwent psychometric and quantitative sensory testing, including assessment of the temporal summation of pain in the presence and absence of a distracting motor task.
  
  
  RESULTS
  A simple distraction task decreased temporal summation of pain overall, but, surprisingly, a greater distraction analgesia was observed in high catastrophizers. This enhanced distraction analgesia in high catastrophizers was not altered when controlling for current pain scores, depression, anxiety, or opioid use (analysis of covariance [ANCOVA]: F=8.7, P<0.005). Interestingly, the magnitude of distraction analgesia was inversely correlated with conditioned pain modulation (Pearson R=-0.23, P=0.005).
  
  
  CONCLUSIONS
  Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing's pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.
authors.affiliation: From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts (K.L.S., S.G., R.N.J., R.R.E.); Department of Psychiatry and Behavioral Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (C.C., A.D.W.); Department of Anesthesiology and Psychiatry, University of Pittsburgh Medical Center (C.C., A.D.W.); Department of Psychiatry, Brigham and Women's Hospital (M.O.M., R.N.J., R.R.E.); and Center for Pain and the Brain, P.A.I.N. Group, Boston Children's Hospital, Boston, Massachusetts (D.B.).
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Schreiber
authors.forename: Claudia
authors.initials: C
authors.lastname: Campbell
authors.forename: Marc O
authors.initials: MO
authors.lastname: Martel
authors.forename: Seth
authors.initials: S
authors.lastname: Greenbaum
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.forename: David
authors.initials: D
authors.lastname: Borsook
authors.forename: Robert N
authors.initials: RN
authors.lastname: Jamison
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001288:Attention; D058443:Catastrophization / Q000523:psychology*; D059350:Chronic Pain / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010812:Physical Stimulation; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid