Attention and pain: a narrative review

Abstract

Background: Attention is a key process in the transformation from nociception until the experience of pain, and in an attempt to function in the presence of pain. Several models have been formulated to account for the reciprocal relationship between pain and attention. A review of current models and their assumption is currently lacking. Methods: We searched and identified a number of theoretical models on the relationship between pain and attention, and interpreted these taking into account the various meanings of attention as proposed by Allport (2012): as a relationship between a subject and an object, as a limitation (resource/capacity; bottleneck), as a control system, and as a bias mechanism. Findings: We identified several models of attention and pain, amongst which a resource/capacity model, a cognitive-affective model, a neuropsychological model and a motivational model. Many models use terms related to attention as a limitation Few models use a motivational perspective, in which attention is best considered as a control system and as a bias mechanism. . Discussion: We discuss the consequences of these models for future research, and consider their implications for interventions in patients with chronic pain. We argue that pain should be re-defined in a motivational perspective: pain energizes and directs behaviour, and may be best reconceptualised as an urge to escape from bodily threat.