Attentional biases towards emotional information in chronic pain: A multilevel meta-analysis of eye-tracking studies

Objective

This meta-analysis reviewed the existing literature on attentional biases towards emotional stimuli measured with eye-tracking methodologies in individuals with chronic pain.

Method

Eighteen relevant studies (n = 1331 participants) were identified through three electronic databases: PubMed, PsycInfo, and Scopus. A multilevel random-effects meta-analysis was conducted by using the standardized mean difference between gaze variables for emotional and neutral stimuli with Hedge's correction as the effect size (ES).

Results

Between-group analyses revealed that healthy individuals make longer first fixation towards neutral stimuli compared to chronic pain patients. Within-group analyses showed that, compared to the healthy control group, the chronic pain group had more first fixations towards pain-related stimuli than to neutral ones and had shorter fixation duration towards anger-related stimuli than to neutral stimuli. A moderation effect of paradigm and type of stimuli was also found.

Conclusions

This is the first meta-analysis exploring attentional biases not only towards pain-related stimuli, but also towards other emotional information. Our findings revealed that chronic pain individuals tend to focus their attention firstly on pain-related information in comparison to healthy individuals. Furthermore, chronic pain individuals maintain their attention on anger-related stimuli less than on neutral ones.