Associations between pain and physical activity among older adults.

OBJECTIVES: Chronic pain is a significant societal problem and pain complaints are one of the main causes of work absenteeism and emergency room visits. Physical activity has been associated with reduced risk of suffering from musculoskeletal pain complaints, but the exact relationship in an older adult sample is not known. METHODS: Participants self-reported their physical activity level and whether they were often troubled by bone, joint, or muscle pain. Logistic regression analyses revealed the nature of the relationship between musculoskeletal pain and physical activity cross-sectionally and longitudinally over the course of 10 years. Data were taken from the English Longitudinal Study of Ageing, comprising of 5802 individuals residing in England aged 50 or older. RESULTS: Only high levels of physical activity were associated with a reduced risk of suffering from musculoskeletal pain compared to a sedentary lifestyle longitudinally. In addition, having low wealth, being female, and being overweight or obese were found to be risk factors for suffering from musculoskeletal pain. CONCLUSIONS: The development of interventions aimed at alleviating and preventing musculoskeletal pain complaints might benefit from incorporating physical activity programs, weight loss, and aspects addressing wealth inequality to maximise their efficacy.

Cognitive performance in pain is predicted by effort, not goal desire.

BACKGROUND: Pain's disruptive effects on cognition are well documented. The seminal goal-pursuit account of pain suggests that cognitive disruption is less likely if participants are motivated to attended to a focal goal and not a pain goal. OBJECTIVES: Existing theory is unclear about the conceptualisation and operationalisation of 'focal goal'. This study aims to clarify how goals should be conceptualised and further seeks to test the theory of the goal-pursuit account. METHODS: In a pre-registered laboratory experiment, 56 participants completed an arithmetic task in high-reward/low-reward and pain/control conditions. Pain was induced via cold-water immersion. RESULTS: High levels of reported effort exertion predicted cognitive-task performance, whereas desire for rewards did not. Post-hoc analyses further suggest that additional effort in the pain condition compensated for pain's disruptive effects, but when this extra effort was not exerted, performance deficits were observed in pain, compared to control, conditions. CONCLUSION: Results suggest that 'motivation', or commitment to a focal goal, is best understood as effort exertion and not as a positive desire to achieve a goal. These results solidify existing theory and aid researchers in operationalising these constructs.

Attentional Biases Towards Body Expressions of Pain in Men and Women.

This study investigated whether there are gender differences in attention to bodily expressions of pain and core emotions. Three experiments are reported using the attentional dot probe task. Images of men and women displaying bodily expressions, including pain, were presented. The task was used to determine whether participants' attention was drawn towards or away from target expressions. Inconsistent evidence was found for an attentional bias towards body expressions, including pain. While biases were affected by gender, patterns varied across the Experiments. Experiment 1, which had a presentation duration of 500 ms, found a relative bias towards the location of male body expressions compared to female expressions. Experiments 2 and 3 varied stimulus exposure times by including both shorter and longer duration conditions (e.g., 100 vs. 500 vs. 1250 ms). In these experiments, a bias towards pain was confirmed. Gender differences were also found, especially in the longer presentation conditions. Expressive body postures captured the attention of women for longer compared to men. These results are discussed in light of their implications for why there are gender differences in attention to pain, and what impact this has on pain behaviour. PERSPECTIVE: We show that men and women might differ in how they direct their attention towards bodily expressions, including pain. These results have relevance to understanding how carers might attend to the pain of others, as well as highlighting the wider role that social-contextual factors have in pain.

Conceptual knowledge of the associativity principle: A review of the literature and an agenda for future research.

Individuals use diverse strategies to solve mathematical problems, which can reflect their knowledge of arithmetic principles and predict mathematical expertise. For example, '6 + 38 - 35' can be solved via '38 - 35 = 3' and then '3 + 6 = 9', which is a shortcut-strategy derived from the associativity principle. The shortcut may be critical for understanding algebra, however approximately 50% of adults fail to use it. We review the research to consider why the associativity principle is challenging and highlight an important distinction between shortcut identification and execution. We also discuss how domain-specific skills and domain-general skills might play an important role in shortcut identification and execution, and provide an agenda for future research.

When driving hurts: characterizing the experience and impact of driving with back pain.

OBJECTIVES: Driving is one of the most widespread aspects of daily living to people in the United States and is an active process that requires various cognitive functions, such as attention. Chronic low back pain (CLBP) is one of the more prevalent and costly health conditions in the world, with individuals who report CLBP also reporting significant impairment across different domains of daily life both physically and cognitively. However, despite the prevalence of these two constructs, research detailing the experience of driving in pain remains largely underrepresented. This cross-sectional study sought to characterize the driving experience of people who experience CLBP, focusing on the psychological constructs related to chronic pain like pain catastrophizing, affective responses (irritability, anxiety, fear), and self-reported driving behaviors and outcomes. METHODS: This study distributed an online questionnaire measuring pain, disability, and other psychological constructs commonly associated with CLBP like pain catastrophizing through M-turk to 307 U.S. participants with recurring CLBP and regular driving activity. Participants also answered questions regarding driving in pain, affective responses to driving in pain (i.e., irritability, anxiety, and fear), driving behaviors and violations, driving avoidance habits as a result of pain, opioid use, using pain medication while driving, and recent vehicle collisions within the past three years. Bivariate correlations were used to compare study variables, and one-way ANOVA's were used to compare means between participants with and without a collision history within the past three years. RESULTS: Findings demonstrated significant positive associations not only between the psychological factors commonly associated with chronic pain, such as pain intensity, pain disability, pain catastrophizing, and the cognitive intrusion by pain, but also statistically significant relationships between these measures and pain intensity while driving, affective responses to driving in pain, driving violations, and driving avoidance habits. Additionally, in comparison to participants with no collision history within the past three years, participants who had been driving during a vehicle collision reported greater pain catastrophizing and cognitive intrusion by pain scores. CONCLUSIONS: To our knowledge, the current study is the first to characterize driving experience specifically among individuals with CLBP, with attention to the relationship among key sensory, affective, and cognitive psychological metrics as well as self-reported driving history and behavior. The current findings reinforce multiple associations between pain and cognitive-affective variables that have been observed in literature outside the driving context, including pain intensity, anger, inattention, and behavioral disruption. Given that driving is a pervasive, potentially risky behavior that requires some form of cognitive focus and control, the current findings point to a continued need to examine these associations within this specific life context. We believe we have laid a groundwork for research considering the role of psychological pain variables in a driving performance. However, the nature of our analyses prevents any sort of causality from being inferred, and that future experimental research is warranted to better understand and explain these mechanisms underlying driving in pain while accounting for participant bias and subject interpretation.

Investigating the role of attention in the identification of associativity shortcuts using a microgenetic measure of implicit shortcut use.

Many mathematics problems can be solved in different ways or by using different strategies. Good knowledge of arithmetic principles is important for identifying and using strategies that are more sophisticated. For example, the problem "6 + 38 - 35" can be solved through a shortcut strategy where the subtraction "38 - 35 = 3" is performed before the addition "3 + 6 = 9," a strategy that is derived from the arithmetic principle of associativity. However, both children and adults make infrequent use of this shortcut and the reasons for this are currently unknown. To uncover these reasons, new sensitive measures of strategy identification and use must first be developed, which was one goal of our research. We built a novel method to detect the time-point when individuals first identify an arithmetic strategy, based on trial-by-trial response time data. Our second goal was to use this measure to investigate the contribution of one particular factor, attention, in the identification of the associativity shortcut. In two studies, we found that manipulating visual attention made no difference to the number of people who identified the shortcut, the trial number on which they first identified it, or their accuracy and response time for solving shortcut problems. We discuss the theoretical and methodological contribution of our findings and argue that the origin of people's difficulty with associativity shortcuts may lie beyond attention.

People in pain make poorer decisions.

Chronic pain affects 1 in 5 people and has been shown to disrupt attention. Here, we investigated whether pain disrupts everyday decision making. In study 1, 1322 participants completed 2 tasks online: a shopping-decisions task and a measure of decision outcomes over the previous 10 years. Participants who were in pain during the study made more errors on the shopping task than those who were pain-free. Participants with a recurrent pain condition reported more negative outcomes from their past decisions than those without recurrent pain. In study 2, 44 healthy participants completed the shopping-decisions task with and without experimentally induced pain. Participants made more errors while in pain than while pain-free. We suggest that the disruptive effect of pain on attending translates into poorer decisions in more complex and ecologically valid contexts, that the effect is causal, and that the consequences are not only attentional but also financial.

An investigation of the effect of experimental pain on logical reasoning.

Pain disrupts attention to prioritise avoidance of harm and promote analgesic behaviour. This could in turn have negative effects on higher-level cognitions, which rely on attention. In the current article, we examined the effect of thermal pain induction on 3 measures of reasoning: the Cognitive Reflection Test, Belief Bias Syllogisms task, and Conditional Inference task. In experiment 1, the thermal pain was set at each participant's pain threshold. In experiment 2, it was set to a minimum of 44°C or 7/10 on a visual analogue scale (whichever was higher). In experiment 3, performance was compared in no pain, low-intensity pain, and high-intensity pain conditions. We predicted that the experience of pain would reduce correct responding on the reasoning tasks. However, this was not supported in any of the 3 studies. We discuss possible interpretations of our failure to reject the null hypothesis and the importance of publishing null results.

Headache Impairs Attentional Performance: A Conceptual Replication and Extension.

Pain is thought to capture our attention. A consequence is that our performance on other tasks may suffer. Research has supported this, showing that pain disrupts our ability to perform various attention tasks. However, the specific nature of the effect of pain on attention is inconsistent, possibly due to different studies investigating different types of pain. Few studies seek to replicate basic findings. In this study, we conceptually replicated and extended the headache study by Moore, Keogh, and Eccleston in 2013, by including 2 additional attention tasks, a broader sample, and measures of affect and pain cognition. Participants performed 5 complex attention tasks and a choice reaction time task with and without a naturally-occurring headache. Headache slowed reaction times to 4 of the 5 complex tasks, and this could be attributed to a slower basic processing speed measured using the choice reaction time task. Our findings differ from those of Moore et al in their headache study, suggesting that the effect of pain on attention is dynamic, even within a given type of pain. Whereas there is growing evidence that pain does disrupt attention, we cannot yet predict the specific nature of disruption in any given case. PERSPECTIVE: We extended a study investigating the effect of headache on attention. Although both studies showed attentional disruption, the specific effects differed. Research must establish when and why the effect of pain on attention varies before we will be able to develop interventions to reduce attentional disruption from pain.

The effect of pain on task switching: pain reduces accuracy and increases reaction times across multiple switching paradigms.

Pain disrupts attention, which may have negative consequences for daily life for people with acute or chronic pain. It has been suggested that switching between tasks may leave us particularly susceptible to pain-related attentional disruption, because we need to disengage our attention from one task before shifting it onto another. Switching tasks typically elicit lower accuracies and/or longer reaction times when participants switch to a new task compared with repeating the same task, and pain may exacerbate this effect. We present 3 studies to test this hypothesis. In study 1, participants completed 2 versions of an alternating runs switching task under pain-free and thermal pain-induction conditions. Pain did not affect performance on either task. In studies 2 and 3, we examined 7 versions of the switching task using large general population samples, experiencing a variety of naturally occurring pain conditions, recruited and tested on the internet. On all tasks, participants with pain had longer reaction times on both switch and repeat trials compared with participants without pain, but pain did not increase switch costs. In studies 2 and 3, we also investigated the effects of type of pain, duration of pain, and analgesics on task performance. We conclude that pain has a small dampening effect on performance overall on switching tasks. This suggests that pain interrupts attention even when participants are engaged in a trial, not only when attention has been disengaged for shifting to a new task set.

The Experience of Cognitive Intrusion of Pain: scale development and validation.

Patients with chronic pain often report their cognition to be impaired by pain, and this observation has been supported by numerous studies measuring the effects of pain on cognitive task performance. Furthermore, cognitive intrusion by pain has been identified as one of 3 components of pain anxiety, alongside general distress and fear of pain. Although cognitive intrusion is a critical characteristic of pain, no specific measure designed to capture its effects exists. In 3 studies, we describe the initial development and validation of a new measure of pain interruption: the Experience of Cognitive Intrusion of Pain (ECIP) scale. In study 1, the ECIP scale was administered to a general population sample to assess its structure and construct validity. In study 2, the factor structure of the ECIP scale was confirmed in a large general population sample experiencing no pain, acute pain, or chronic pain. In study 3, we examined the predictive value of the ECIP scale in pain-related disability in fibromyalgia patients. The ECIP scale scores followed a normal distribution with good variance in a general population sample. The scale had high internal reliability and a clear 1-component structure. It differentiated between chronic pain and control groups, and it was a significant predictor of pain-related disability over and above pain intensity. Repairing attentional interruption from pain may become a novel target for pain management interventions, both pharmacologic and nonpharmacologic.

The disruptive effects of pain on n-back task performance in a large general population sample.

Pain captures attention, displaces current concerns, and prioritises escape and repair. This attentional capture can be measured by its effects on general cognition. Studies on induced pain, naturally occurring acute pain, and chronic pain all demonstrate a detrimental effect on specific tasks of attention, especially those that involve working memory. However, studies to date have relied on relatively small samples and/or one type of pain, thus restricting our ability to generalise to wider populations. We investigated the effect of pain on an n-back task in a large heterogeneous sample of 1318 adults. Participants were recruited from the general population and tested through the internet. Despite the heterogeneity of pain conditions, participant characteristics, and testing environments, we found a performance decrement on the n-back task for those with pain, compared with those without pain; there were significantly more false alarms on nontarget trials. Furthermore, we also found an effect of pain intensity; performance was poorer in participants with higher intensity compared with that in those with lower intensity pain. We suggest that the effects of pain on attention found in the laboratory occur in more naturalistic settings. Pain is common in the general population, and such interruption may have important, as yet uninvestigated, consequences for tasks of everyday cognition that involve working memory, such as concentration, reasoning, motor planning, and prospective memory.

Advanced mathematical study and the development of conditional reasoning skills.

Since the time of Plato, philosophers and educational policy-makers have assumed that the study of mathematics improves one's general 'thinking skills'. Today, this argument, known as the 'Theory of Formal Discipline' is used in policy debates to prioritize mathematics in school curricula. But there is no strong research evidence which justifies it. We tested the Theory of Formal Discipline by tracking the development of conditional reasoning behavior in students studying post-compulsory mathematics compared to post-compulsory English literature. In line with the Theory of Formal Discipline, the mathematics students did develop their conditional reasoning to a greater extent than the literature students, despite them having received no explicit tuition in conditional logic. However, this development appeared to be towards the so-called defective conditional understanding, rather than the logically normative material conditional understanding. We conclude by arguing that Plato may have been correct to claim that studying advanced mathematics is associated with the development of logical reasoning skills, but that the nature of this development may be more complex than previously thought.

Individual differences in inhibitory control, not non-verbal number acuity, correlate with mathematics achievement.

Given the well-documented failings in mathematics education in many Western societies, there has been an increased interest in understanding the cognitive underpinnings of mathematical achievement. Recent research has proposed the existence of an Approximate Number System (ANS) which allows individuals to represent and manipulate non-verbal numerical information. Evidence has shown that performance on a measure of the ANS (a dot comparison task) is related to mathematics achievement, which has led researchers to suggest that the ANS plays a critical role in mathematics learning. Here we show that, rather than being driven by the nature of underlying numerical representations, this relationship may in fact be an artefact of the inhibitory control demands of some trials of the dot comparison task. This suggests that recent work basing mathematics assessments and interventions around dot comparison tasks may be inappropriate.

Non-verbal number acuity correlates with symbolic mathematics achievement: but only in children.

The process by which adults develop competence in symbolic mathematics tasks is poorly understood. Nonhuman animals, human infants, and human adults all form nonverbal representations of the approximate numerosity of arrays of dots and are capable of using these representations to perform basic mathematical operations. Several researchers have speculated that individual differences in the acuity of such nonverbal number representations provide the basis for individual differences in symbolic mathematical competence. Specifically, prior research has found that 14-year-old children's ability to rapidly compare the numerosities of two sets of colored dots is correlated with their mathematics achievements at ages 5-11. In the present study, we demonstrated that although when measured concurrently the same relationship holds in children, it does not hold in adults. We conclude that the association between nonverbal number acuity and mathematics achievement changes with age and that nonverbal number representations do not hold the key to explaining the wide variety of mathematical performance levels in adults.

Measuring the approximate number system.

Recent theories in numerical cognition propose the existence of an approximate number system (ANS) that supports the representation and processing of quantity information without symbols. It has been claimed that this system is present in infants, children, and adults, that it supports learning of symbolic mathematics, and that correctly harnessing the system during tuition will lead to educational benefits. Various experimental tasks have been used to investigate individuals' ANSs, and it has been assumed that these tasks measure the same system. We tested the relationship across six measures of the ANS. Surprisingly, despite typical performance on each task, adult participants' performances across the tasks were not correlated, and estimates of the acuity of individuals' ANSs from different tasks were unrelated. These results highlight methodological issues with tasks typically used to measure the ANS and call into question claims that individuals use a single system to complete all these tasks.