A contextual analysis of attention to chronic pain: What the patient does with their pain might be more important than their awareness or vigilance alone

It is often believed that to feel greater pain is to experience greater effects of that pain, and that attention and awareness represent the transmission mechanism in this relationship. By implication, it is assumed that if attention and awareness can be lessened, the effects of pain will likewise reduce. Despite conceptual work and data suggesting more complex processes might indeed be in place, these long-standing and intuitively appealing ideas remain, either explicitly or implicitly, in both research and clinical applications. The purpose of this study was to compare the role of attentional processes in chronic pain with a process that is more contextual, functional, and behavior-focused, namely, acceptance. The hypothesis tested is whether it is more important to understand the amount of contact an individual has with pain, in this case awareness and vigilance to pain, or the degree of influence on behavior brought with that contact, in this case acceptance. Data from 227 patients seeking treatment for chronic pain were examined. Results from correlation analyses showed that acceptance scores achieved stronger correlations than scores for the attention variables with measures of cognitive, emotional, social, and physical functioning. When acceptance of pain was taken into account in multiple regression analyses, scores from the attention measures accounted for little or no variance in measures of patient functioning. The value of various mental, mechanical, behavior-focused, and contextual models of attention in chronic pain is discussed. Perspective: Attention, awareness, and vigilance appear immediately applicable for understanding chronic pain. These processes, however, might be incomplete in accounting for pain-related suffering and disability. Acceptance is proposed as a process that expands the frame work of attention to include varying cognitive, emotional, and social influences exerted by pain on patient behavior. (C) 2007 by the American Pain Society.