Pain, 41 (1990) 109-114 Elsevier PAIN 01575 109 The effects of distraction on responses to cold pressor pain ’ Robert L. Hodes, Eric W. Howland, Nancy Lightfoot and Charles S. Cleeland Pain Research Group, Dept. of Neurology, 648 W ARE 610 W alnut St., Madison, W I 53705 (U.S.A.) (Received 1 August 1979, revision received 7 December 1989, accepted 13 December 1989) summary Subjective pain ratings and tolerance time were obtained during 2 cold pressor immersions for 3 groups of subjects. During the second immersion 1 group performed no task and the other 2 groups performed either an easy or difficult mental arithmetic task. The sensory-discriminative response to pain was measured by pain ratings. Pain ratings were collected every minute until subjects removed their arm from the cold pressor or until 4 min passed. Relative to a baseline cold pressor immersion, subjects in both the distraction conditions reduced their 1 min pain ratings more than control subjects. This effect was weaker at the 2 min pain rating and absent at the later ratings. The affective-reactive response to pain was measured by pain tolerance times. Tolerance time was defined as the time when subjects removed their arm from the cold pressor. Tolerance time was not altered by the distraction tasks. These findings suggest that affectively neutral distraction alters the sensory but not the reactive response to pain. Clinical implications are discussed. Key words: Distraction; Attention; Cold pressor; Pain ratings; Pain tolerance zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONML Introduction Folk wisdom and modem behavioral psy- chology both appreciate the power of distraction in reducing the distress associated with painful stimulation. McCaul and Malott [9] recently re- viewed laboratory studies on distraction and con- cluded that distraction procedures are superior to appropriate control interventions in producing analgesia. In their model, the analgesic property of distraction is attributed to the relative potency of the distractor as opposed to nociception in captur- ’ This research was supported by Grant No. NS22677 pro- vided by the National Institutes of Health. Correspondence to: C.S. Cleeland, Pain Research Group, Dept. of Neurology, 648 WARF, 610 Walnut St., Madison, WI 53705, U.S.A. ing the limited capacity of the brain’s perceptual processing mechanisms. This model can be tested by comparing the analgesic properties of complex distracters with the analgesia produced by control procedures. Barber and Cooper [l] used a pressure pain proce- dure and found that pain ratings were lower dur- ing story listening and serial addition by 7s as compared to the simpler task of counting by 1s. Horan and Dellinger [5] compared the analgesic effects of counting backwards by 1 (presumably a simple cognitive task) with relaxing imagery on cold pressor pain. As expected, imagery subjects tolerated cold pressor stimulation for twice as long as did subjects in the counting condition. These data support the potency of distracters in inhibiting pain response. However, 2 problems prevent a full endorsement of this conclusion. First, the above studies are flawed by their selec- 0304-3959/90/$03.50 0 1990 Elsevier Science Publishers B.V. (Biomedical Division)