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      Attentional Bias Toward Cupping Therapy Marks: An Eye-Tracking Study

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          Despite the many medical benefits, cupping therapy can be difficult for some patients due to unpleasant marks on the skin. As patients are afraid of the potential painful sensation from cupping therapy, the skin reactions might produce vigilance for treatment as pain-related information. We investigated whether individuals show negative emotions and attentional bias toward pain-related residual marks from cupping therapy on the body using an eye-tracking method.


          Fifty pain-free volunteers were presented with four different kinds of visual stimulation, such as the back or face region and with or without cupping marks on the skin. A cupping and a control image were presented on one screen with one image on the left side of the screen and the other on the right (locations of the images were counterbalanced across participants). The eye movements of the participants were measured while they viewed the pictures. They completed the Empathy Quotient questionnaire before the experiment and evaluated the unpleasantness level to each image during the task.


          Images of the back and face with cupping marks were rated significantly more unpleasant and showed a significant attentional bias (significantly longer percentage fixation time) than the control images (attentional bias score: Back + cupping: 48.1 ± 2.8%; Back: −0.7 ± 3.4%; Face + cupping: 34.5 ± 2.5%; Face: −2.2 ± 2.9%). Individuals with greater empathy exhibited significantly higher unpleasantness ( r = 0.323, p < 0.05) and less attentional bias ( r = −0.279, p < 0.05) to the images with cupping marks.


          The skin reactions caused by cupping therapy evoked negative emotional responses as well as attentional bias to the reaction sites. Our findings suggest that the emotional and attentional responses to cupping therapy might reflect potential reluctance to this therapy.

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          Most cited references 28

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          Empathy for pain involves the affective but not sensory components of pain.

          Our ability to have an experience of another's pain is characteristic of empathy. Using functional imaging, we assessed brain activity while volunteers experienced a painful stimulus and compared it to that elicited when they observed a signal indicating that their loved one--present in the same room--was receiving a similar pain stimulus. Bilateral anterior insula (AI), rostral anterior cingulate cortex (ACC), brainstem, and cerebellum were activated when subjects received pain and also by a signal that a loved one experienced pain. AI and ACC activation correlated with individual empathy scores. Activity in the posterior insula/secondary somatosensory cortex, the sensorimotor cortex (SI/MI), and the caudal ACC was specific to receiving pain. Thus, a neural response in AI and rostral ACC, activated in common for "self" and "other" conditions, suggests that the neural substrate for empathic experience does not involve the entire "pain matrix." We conclude that only that part of the pain network associated with its affective qualities, but not its sensory qualities, mediates empathy.
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            Attentional bias to pain-related information: a meta-analysis.

            This meta-analysis investigated whether attentional bias, that is, the preferential allocation of attention to information that is related to pain, is a ubiquitous phenomenon. We also investigated whether attentional bias effects are related to the methodological quality of the study, to procedural differences in their measurement, or to individual differences in pain severity, pain-related fear, anxiety, and depression. Results indicated that individuals who experience chronic pain (n=1023) display an attentional bias towards pain-related words or pictures, but this bias was of a small effect size (d=0.134), and did not differ from that in control groups (d=0.082; n=1398). No evidence was found for an attentional bias towards pain-related words and pictures for acute pain (d=0.049), procedural pain (d=0.142), and experimental pain (d=0.069). However, research in which attentional bias towards signals of impending experimental pain in healthy volunteers was investigated, revealed an attentional bias of medium effect size (d=0.676). Moderator analyses in the chronic pain group identified important procedural variables that affected the presence and magnitude of an attentional bias towards pain-related words and pictures, that is, type and exposure time of pain-related information. None of the individual difference variables affected the magnitude of the attentional bias. Implications of current findings and future directions are discussed.
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              Attentional bias towards pain-related information in chronic pain; a meta-analysis of visual-probe investigations.

              Research investigating the presence of attentional bias in chronic pain has produced mixed results. The purpose of this review is to summarise former research using the visual-probe task to explore attentional bias in pain populations, and meta-analyse the results of controlled investigations comparing individuals with chronic pain to healthy controls. Ten eligible studies were included in this analysis (chronic pain n=515, control n=314). Overall, individuals with chronic pain were found to show significantly greater bias towards pain-related information compared to controls, with an effect size of .36 (Hedges' adjusted g). The time-course of attentional bias was also explored, with evidence found for significant bias during stages of initial orienting of attention (effect size .29) and maintained attention (effect size .42). Bias therefore appears more pronounced during later stages of attention, possibly arising from processes of rumination. It is important for future research to fully explore the role attentional bias plays in the causation and maintenance of chronic pain, and the potential consequences bias may have upon quality of life.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                18 May 2020
                : 13
                : 1041-1047
                [1 ]Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
                Author notes
                Correspondence: Younbyoung Chae Email ybchae@khu.ac.kr

                These authors contributed equally to this work

                © 2020 Hong et al.

                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).

                Page count
                Figures: 3, References: 34, Pages: 7
                Original Research

                Anesthesiology & Pain management

                eye-tracking, empathy, emotion, cupping, attentional bias


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