Zerbini Giulia, Strömel-Scheder Cindy, Karmann Anna, Lang Philip, Kunz Miriam, Lautenbacher Stefan
Department of Medical Psychology and Sociology, Institute of Theoretical Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
Physiological Psychology, University of Bamberg, Bamberg, Germany.
Br J Pain. 2025 May 11:20494637251342005. doi: 10.1177/20494637251342005.
Persons with chronic pain suffer from additional symptoms and deficits that are directly or indirectly related to their condition. Attentional deficits are a common problem in these individuals. The same is true for sleep disturbances. It is well-known that night sleep affects attention the next day. Therefore, sleep disturbances might be responsible for the association between chronic pain and deficits in attention.
We studied the gaze behaviour (absolute and relative fixation times, i.e., attentional biases) in patients with chronic musculoskeletal pain ( = 20) and pain-free individuals ( = 28). For that purpose, we used an eye-tracker to monitor gaze behaviour during the presentation of affective stimuli, that is, pictures of faces displaying joy, anger, pain, and neutral expressions. In addition, we assessed subjective/wellbeing parameters, as well as objective sleep parameters with a portable polysomnography (PSG) device during two nights at home, with the aim of testing the mediating role of sleep for the relationship between chronic pain and alterations of attention.
Patients with chronic pain exhibited overall shorter fixation times (on average ∼160 ms shorter fixation times). With respect to the attentional biases, all participants looked longer at the affective faces compared to the neutral ones, independent of group or type of affective stimulus. Several subjective sleep/wellbeing parameters, together with two PSG parameters (sleep efficiency and duration of awakenings), were significantly worse in patients with chronic pain. Despite this, only subjective sleep quality and sleep efficiency mediated the association of chronic pain and attentional processes.
Our findings confirm previous studies showing attentional deficits and sleep disturbances in patients with chronic pain. However, our results only partially support the hypothesis that the relationship between chronic pain and altered attentional processes is due to disturbed sleep. Other mechanisms might be involved, highlighting the need for further studies.
慢性疼痛患者会出现一些与其病情直接或间接相关的附加症状和功能缺陷。注意力缺陷是这些患者的常见问题。睡眠障碍也是如此。众所周知，夜间睡眠会影响次日的注意力。因此，睡眠障碍可能是慢性疼痛与注意力缺陷之间关联的原因。
我们研究了慢性肌肉骨骼疼痛患者（n = 20）和无疼痛个体（n = 28）的注视行为（绝对和相对注视时间，即注意力偏差）。为此，我们使用眼动仪在呈现情感刺激（即显示喜悦、愤怒、疼痛和中性表情的面部图片）期间监测注视行为。此外，我们在家中两晚使用便携式多导睡眠图（PSG）设备评估主观/幸福感参数以及客观睡眠参数，目的是测试睡眠在慢性疼痛与注意力改变之间关系中的中介作用。
慢性疼痛患者的总体注视时间较短（平均注视时间短约160毫秒）。关于注意力偏差，所有参与者看情感面孔的时间都比看中性面孔的时间长，与组别或情感刺激类型无关。慢性疼痛患者的几个主观睡眠/幸福感参数以及两个PSG参数（睡眠效率和觉醒时长）明显更差。尽管如此，只有主观睡眠质量和睡眠效率介导了慢性疼痛与注意力过程之间的关联。
我们的研究结果证实了先前的研究，即慢性疼痛患者存在注意力缺陷和睡眠障碍。然而，我们的结果仅部分支持慢性疼痛与注意力改变之间的关系是由于睡眠障碍这一假设。可能涉及其他机制，这凸显了进一步研究的必要性。
