Altered pain-related attention engagement in individuals with chronic musculoskeletal pain: Evidence from EM-ERP.

OBJECTIVES: We investigated neurocognitive mechanisms of pain-related attentional control in individuals with chronic musculoskeletal pain. METHODS: By simultaneously recording eye movements and event-related potentials (ERPs), we examined pain-related attentional control in a sample with chronic musculoskeletal pain (N = 26) and a matched pain-free control group (N = 26). Using an adapted go/no-go paradigm, the go condition required participants to focus on pain or neutral images to measure attention engagement while the no-go condition required inhibiting attention toward these images to measure attention inhibition. RESULTS: In the go condition, participants with chronic musculoskeletal pain exhibited shorter first fixation latencies and longer dwell times on pain images than neutral images, indicating enhanced attentional vigilance and maintained attention engagement. These behavioral effects were fully mediated by enhanced pain image-evoked N2 amplitude biases and partially mediated by pain image-evoked P3 amplitude biases, respectively. N2 amplitudes reflected initial top-down attentional capture, and P3 amplitudes reflected maintained attention engagement regulation. No differences in eye movements or ERPs were observed during the no-go condition in either group. DISCUSSION: People with chronic musculoskeletal pain display enhanced pain-related attention engagement that suggests pain-related attention control deficits. Future research that aims to improve pain-related attentional control by targeting maladaptive patterns of attention engagement may lead to better chronic pain outcomes.