An electronic diary assessment of the effects of distraction and attentional focusing on pain intensity in chronic low back pain patients.

Objective: The present study examined the effects of a manipulation of attention to pain (i.e. attentional focusing vs. distraction) on pain intensity in daily life of patients with chronic low back pain. It was hypothesized that attentional focusing would lead to decreased pain intensity in high pain fearful individuals, whereas distraction from pain would be associated with decreased pain intensity in low pain fearful individuals.

Design: An experience sampling methodology was used to examine the effects of a manipulation of attention to pain on pain intensity in daily life of pain patients.

Methods: A total number of 38 patients with chronic low back pain participated in this study and carried a palmtop computer for 2 weeks. During this period, patients were 'beeped' 8 times a day to complete diary questions. On certain days, instructions to either attend to or distract from pain were given.

Results: Multi-level analyses showed that attentional focusing was not associated with decreased pain intensity in high pain fearful individuals and that distraction did not lead to decreased pain intensity in low pain fearful individuals. The manipulations in isolation neither influenced pain intensity. The manipulation check was generally weak.

Conclusion: A manipulation of attention to pain in daily life of patients with chronic low back pain proved difficult to accomplish. As the manipulation check was generally unsuccessful, no clear inferences about the underlying theory can be made. Future research within the field of pain treatments (e.g. in vivo exposure) might benefit greatly from electronic diary assessments studies.