Clinical pain, abstraction, and self-control: being in pain makes it harder to see the forest for the trees and is associated with lower self-control

Journal of Pain Research Dovepress open access to scientific and medical research ORIGINAL RESEARCH Journal of Pain Research downloaded from https://www.dovepress.com/ by 5.135.15.0 on 13-Jul-2018 For personal use only. Open Access Full Text Article Clinical pain, abstraction, and self-control: being in pain makes it harder to see the forest for the trees and is associated with lower self-control This article was published in the following Dove Press journal: Journal of Pain Research Helena Gunnarsson 1,2 Jens Agerström 1 1 Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; 2Helsa Vårdcentral, Osby, Sweden Objectives: Although abstract thinking is a fundamental dimension of human cognition, it has received scant attention in research on pain and cognition. We hypothesized that physical pain impairs abstraction, because when people experience pain at high intensity levels, attention becomes concretely focused on the self in the here and now, where little else matters than finding relief for the pain they are currently experiencing. We also examined the relationship between pain and self-control, predicting that pain would debilitate self-control. Patients and methods: Abstraction and self-reported self-control were assessed in 109 patients with musculoskeletal pain. The influence of specific pain qualities, such as pain intensity, pain interference with daily activities, pain duration, and pain persistence, was examined. Furthermore, we assessed other factors (e.g., anxiety, depression, and fatigue) that could be assumed to play a role in the pain experience and in cognitive performance. Results: Higher pain intensity and persistence were associated with less abstract thinking. Furthermore, self-control decreased with greater pain intensity, persistence, and self-reported pain interference with daily activities. Self-reported depressive symptoms mediated the overall relationship between pain and self-control. Conclusion: Abstraction is compromised in patients reporting higher pain intensity and persistence. Different dimensions of pain also predict lower self-control although depression seems to account for the relationship between overall pain and self-control. The current study is the first to report an association between clinical musculoskeletal pain and abstraction. The results suggest that pain patients may suffer from a broader range of cognitive disadvantages than previously believed. Keywords: abstraction, self-control, clinical pain, musculoskeletal pain, cognition Introduction Correspondence: Helena Gunnarsson Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, 35195 Växjö, Sweden Tel +46 772 28 8000 Fax +46 470 83217 Email What exactly is abstraction? Abstraction is typically conceptualized as a process of information reduction, making effective storage and categorization of central knowledge possible.5 It is characterized 1105 submit your manuscript | www.dovepress.com Journal of Pain Research 2018:11 1105–1114 Dovepress © 2018 Gunnarsson and Agerström. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/JPR.S163044 Powered by TCPDF (www.tcpdf.org) In the clinic, chronic pain patients often report problems with cognitive function,1 and a body of research has investigated the impact of pain on cognitive functions in clinical pain states.2–4 Despite its central role in human cognition,5–7 abstraction has received sparse attention in pain research. This is surprising given that it also plays a critical role in behavior with important societal implications such as learning, creativity, selfregulation, and moral behavior.5,7 Journal of Pain Research downloaded from https://www.dovepress.com/ by 5.135.15.0 on 13-Jul-2018 For personal use only. Gunnarsson and Agerström by holistic, “gist-based” thinking that allows us to see the broader picture – the proverbial forest for the trees.7 Abstraction thus highlights the superordinate meaning of action rather than its detailed mechanics.8 For example, it is typically characterized by a focus on why actions are performed, as opposed to how they are performed. To illustrate, the act of writing an article could be construed concretely as “pressing keys on the computer”, or more abstractly as “communicating results to the scientific community”. Whether people think abstractly or concretely has multiple determinants, ranging from individual differences in cognitive style to contextual variables, such as power.5 One of the most extensively studied influences of abstract thinking is psychological distance. Research has shown that when the psychological distance from an object or event becomes larger, people use more abstract information processing.7 This happens, for example, when we think about other people as opposed to ourselves (social distance), when we decide for the future rather than the present (temporal distance), and when we contemplate the hypothetical situation instead of the real situation (hypotheticality). Conversely, a focus on the self, here and now, reflects more concrete thinking. Whether abstract thinking is beneficial depends on the context and the task at hand.7 For example, abstraction can help us see the bigger picture and think outside the box when solving problems.9 At the same time, abstract, oversimplified representations of future situations are believed to cause various forms of planning errors including the common tendency for people to underestimate the time required to complete a given project.10 To the best of our knowledge, only two studies have examined the impact of pain on abstraction. In a laboratory experiment where pain was manipulated using the cold pressor method, it was found that pain-induced participants did not differ from pain-free control participants with respect to abstraction, suggesting that abstraction at least seems to be relatively immune to short-lived, acute pain, although the experiment did not have sufficient power to rule out small effects of pain on abstraction.11 In another article, no evidence for an association between pain interference with daily activities and abstraction in a sample of chronic pain patients was found.12 The authors of this study tested the specific hypothesis that experiencing pain on a daily basis would interfere with abstract action identification (...truncated)