Do patients with chronic pain selectively attend to pain-related information?: preliminary evidence for the mediating role of fear Gordon J.G. Asmundson a,b, *, Jenora L. Kuperos b , G. Ron Norton c a Clinical Research and Development Program, Regina Health District, 2180 23rd Avenue, Regina, Saskatchewan, S4S 0A5 Canada b Department of Psychology, University of Regina, Regina, Saskatchewan, S4S 0A5 Canada c Department of Psychology, University of Winnipeg, Winnipeg, Manitoba, Canada Received 2 December 1996; revised version received 14 February 1997; accepted 7 March 1997 Abstract Preliminary evidence from a study using a modified Stroop paradigm suggests that individuals with chronic pain selectively attend to pain-related information. The current study was conducted in an attempt to replicate and extend this finding. Nineteen patients with chronic pain stemming from musculoskeletal injury and 22 healthy control subjects participated. All participants completed a computerised task designed to evaluate attentional allocation to cues thematically related to pain and injury via measurement of detection latencies for dot- probes that followed their presentation. Results indicated that patients did not differ from control subjects in their pattern of responses to dot-probes that were presented following either the pain- or injury-related cues. This pattern of results continued to hold true after including level of depression as a covariate in the analysis. However, when patients were divided on the basis of scores on the Anxiety Sensitivity Index (Peterson, R.A. and Reiss, S., Anxiety Sensitivity Index Manual, 2nd edn., International Diagnostic Systems, Worthington, OH, 1992), a measure related to fear of pain (Asmundson, G.J.G. and Norton, G.R., Behav. Res. Ther., 34 (1996) 545–554), those with low anxiety sensitivity shifted attention away from stimuli related to pain whereas those with high anxiety sensitivity responded similarly to dot- probes regardless of the parameters of presentation. These results suggest that the operation of the information processing system in patients with chronic pain may be dependent on a patient’s trait predisposition to fear pain. Theoretical and ecological implications are discussed.  1997 International Association for the Study of Pain. Published by Elsevier Science B.V. Keywords: Chronic pain; Selective attention; Dot-probe paradigm; Fear of pain; Anxiety sensitivity 1. Introduction Investigators have recently extended the use of paradigms commonly used to assess information processing biases in anxiety disorders (for review, see Logan and Goetsch, 1993) to a variety of other clinical syndromes, including chronic pain. The most widely used task in the assessment of pro- cessing biases has been the modified Stroop (1935) colour- naming paradigm. In this paradigm, subjects are shown a series of cues which differ in emotional valence and are asked to name the colour in which a cue is presented while ignoring its meaning. Delays in colour-naming (i.e., Stroop interference) and, by inference, selective attentional processing, occur when the meaning of a cue attracts the subject’s attention despite attempts to ignore it. In general, the results of studies employing modified Stroop tests pro- vide an indication of the environmental cues which are attended to by individuals with specific clinical syndromes. These cues typically include those that are of personal rele- vance (Riemann and McNally, 1995) and are often related to themes of threat (McNally, 1994). To illustrate, spider phobics exhibit Stroop interference for spider-related, but not neutral, cues (Watts et al., 1986). In addition, these cues may represent appropriate targets for focused cognitive- behavioural intervention (Asmundson and Stein, 1995) and can be used in conjunction with modified Stroop testing to demonstrate effects of treatment (Mattia et al., 1993). While there have been several studies to address memory biases for pain-related information (e.g., Pearce et al., 1990; Edwards et al., 1992; Edwards and Pearce, 1994; Pincus et Pain 72 (1997) 27–32 0304-3959/97/$17.00  1997 International Association for the Study of Pain. Published by Elsevier Science B.V. PII S0304-3959(97)00010-9 * Corresponding author.