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      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

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          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.


          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.


          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.

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          Most cited references 42

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          High self-control predicts good adjustment, less pathology, better grades, and interpersonal success.

          What good is self-control? We incorporated a new measure of individual differences in self-control into two large investigations of a broad spectrum of behaviors. The new scale showed good internal consistency and retest reliability. Higher scores on self-control correlated with a higher grade point average, better adjustment (fewer reports of psychopathology, higher self-esteem), less binge eating and alcohol abuse, better relationships and interpersonal skills, secure attachment, and more optimal emotional responses. Tests for curvilinearity failed to indicate any drawbacks of so-called overcontrol, and the positive effects remained after controlling for social desirability. Low self-control is thus a significant risk factor for a broad range of personal and interpersonal problems.
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            Out of Control: Visceral Influences on Behavior

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              The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.

              Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                15 June 2018
                : 11
                : 1105-1114
                [1 ]Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
                [2 ]Helsa Vårdcentral, Osby, Sweden
                Author notes
                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 helena.gunnarsson@ 123456lnu.se
                © 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.

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