Pain in focus: How persistent pain disrupts the attentional bias towards pain-related information

Pain modulates attentional biases, contributing to chronic pain development and maintenance through enhanced focus on pain-related stimuli. This study employed drift-diffusion modeling (DDM) and multivariate EEG to investigate how sustained pain affects attention allocation. Using a crossover design, 58 healthy volunteers underwent two sessions (capsaicin-induced pain vs. control cream) while performing word- and picture-based dot-probe tasks. Probes appeared in locations either congruent or incongruent with pain-related stimuli, or after neutral stimulus pairs. Behavioral and neural responses to congruency and incongruency effects were compared between pain states. DDM revealed increased incongruency effects during pain, characterized by slower drift rates and narrower decision thresholds, suggesting impaired evidence accumulation. EEG analyses revealed two distinct pain-state modulations: (1) amplified P3 amplitudes (300-600 ms) during incongruent trials, and (2) multivariate decoding of δ/θ oscillations (1-7 Hz, 116-364 ms post-stimulus) that uniquely differentiated incongruent from neutral conditions specifically under pain. These behavioral and neural signatures of attentional disruption manifested selectively during verbal tasks, with no parallel effects observed in pictorial processing. Our findings demonstrate how pain disrupts cognitive control: impaired expectancy processing (early δ/θ oscillations), compromised decision formation (altered DDM parameters), and deficient response inhibition (P3 modulation). These results highlight verbal information processing as a key vulnerability in pain-related attentional bias, suggesting targeted interventions for cognitive control components could mitigate chronic pain consequences.