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New research focuses on why chronic pain sufferers find it hard to concentrate

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The hypothesis was that sufferers were unconsciously searching for things that would alleviate or exacerbate their chronic pain.

There were times when Hazel Godfrey’s chronic pain was so bad she considered abandoning her PhD, which was investigating why persistent pain makes it difficult for people to think.

Godfrey has fibromyalgia, which causes muscle and joint pain along with draining fatigue. But she persevered for the sake of the many other people with chronic pain who took part in the time-consuming, one-on-one studies she conducted at Victoria University’s cognitive and affective neuroscience laboratory.

Macro alias: ModuleRenderer

“My participants were so awesome,” says Godfrey, who will graduate with a PhD in psychology this month. “They helped me to keep going when it would have been really easy to stop because I felt really unwell. I had many people who went out of their way to participate in my studies. They were really supportive of the fact that I was doing research that might lead to more understanding of chronic pain.”

Godfrey hypothesised that people with chronic pain find it difficult to focus on everyday tasks because they are unconsciously continually searching their environment for things that will alleviate or exacerbate their pain – a tendency called attentional bias. While her results suggest it is not the cause of the cognitive difficulties, she’s happy to have pushed the boundaries of knowledge in the field a bit further.

“I wanted to discover why people with chronic pain find it hard to think. I haven’t found the answer, but someone else might. The fact that attentional bias doesn’t seem to affect thinking means someone else can look at a different type of attention, or at memory, or decision-making.”

Like the 20% of people who experience chronic pain – often described as pain that does not go away as expected after an illness or injury – Godfrey knows just how distracting it can be.

“People with long-term pain find it difficult to think; they feel foggy and forgetful.”

Hazel Godfrey.

It wasn’t until her condition flared up, after she had finished an MSc in psychology in 2011, that she became interested in finding out why pain affects thinking. She was so unwell she had to resign from her job as a public servant and spent a lot of time in bed. She also attended a pain management programme at Wellington Hospital. “The staff gave me lots of tools to help me deal with my pain. They also talked to me about current pain science and I realised I had all these research questions.”

In particular, she wanted to explore the role of attentional bias in the cognitive difficulties experienced by people with chronic pain. If it proved to be the cause, their thinking difficulties could potentially be treated by attentional bias modification. It’s already being used – with variable results – to treat conditions such as depression and anxiety, through the use of smartphone apps that claim to train people to focus their attention away from threats and negativity.

For her PhD, Godfrey conducted two computer-based studies comparing the performance of people with and without chronic pain.

In the first study, participants had to identify words that flashed briefly on a screen; some words were neutral and some were pain-related, such as “burning”. In the second study, they had to respond to a particular symbol when it flashed on a screen at the same time as either a neutral or a pain-related image.

In both studies there was no difference in how much attention the two groups paid to pain-related information, though the response rate of the group with chronic pain was slower than those without it – more proof that pain does affect thinking.

Godfrey says that means attentional bias modification is unlikely to be an effective way of treating the cognitive difficulties caused by chronic pain. However, she’s hopeful a treatment will eventually become available.

“Once we understand the underlying mechanisms, we can develop targeted strategies to manage people’s difficulties in thinking.”

This article was first published in the May 19, 2018 issue of the New Zealand Listener.