Pain attenuation during task: a proof-of-concept study for a new scoring metric to capture individual differences in chronic pain changes by task engagement

Source abstract

Introduction Distraction-based coping strategies are beneficial for some people living with chronic pain. However, there is no established method to capture the individual effect of distraction from pain through task engagement that considers fluctuations in chronic pain and the clinical relevance of changes in pain. Here, we present a new scoring system that aims to capture individual differences in the effect of distraction through task engagement in the context of chronic pain and considers whether changes are clinically meaningful. Methods We determined whether chronic pain attenuation during a task (PAT) is related to task engagement in cognitive attention-demanding numeric tasks that vary in difficulty, in people with chronic pain with different degrees of neuropathic pain based on painDETECT scores. Data from healthy controls (HCs, n = 27) were used to assess whether chronic pain impacted simple motor ability based on reaction time (RT) in a button-press task. In each person with chronic pain ( n = 27), we determined their PAT scores and absolute change in chronic pain intensity and unpleasantness during both a simple motor control task and a hard task. Results There were four main findings: (1) There was no relationship between PAT scores and task engagement in the hard task. (2) RTs were slower and more inconsistent in the chronic pain group compared to the HCs in the simple task, suggestive of diminished psychomotor abilities in the chronic pain group. (3) Mean RTs were negatively correlated with PAT scores for pain intensity in the simple task, with a greater per cent reduction of pain intensity for those with faster RTs. (4) Individuals with chronic pain who experienced increases in pain during the task had the highest painDETECT scores. Discussion This suggests that automated tasks may be useful in temporarily lowering chronic pain intensity. Additionally, the degree of neuropathic pain may diminish the distraction effect on chronic pain. The PAT scoring system has the potential to capture the individual effect of chronic pain attenuation during task engagement, and there may be unique pain-related characteristics between PAT sub-groups that require further exploration. We encourage more validation research of PAT's utility and identify beneficiaries of attention-based pain management approaches that use distraction to manage chronic pain.