Working Through the Pain: A Controlled Study of the Impact of Persistent Pain on Performing a Computer Task

Objectives: A large percentage of employees experience persistent pain while at work. This situation can become costly to employers with large amounts of lost production-time, absenteeism, and long-term disability. The link or transition between working through (ignoring) pain and disabling pain is unknown. This paper presents the results of a controlled study examining the impact of persistent pain on performance in a working population. Benefits of early detection are discussed. Methods: This was a controlled, repeated measures study using 3 types of measures: questionnaires (pain, pain anxiety, daily memory, and attention mistakes); actigraphic monitoring to assure the absence of sleep deprivation; and the Performance Assessment Battery, a computer-based series of tests. Participants were studied during 3 time periods (9:00 AM, 3:00 PM, and 9:00 PM). Results: Forty participants (20 pain, 20 controls) were studied. For all tasks, pain participants were slower than controls with significant findings on 2 tasks and less accurate with significant differences on 1 task. Discussion: Unlike other studies that either induced pain or used persons with complex pain conditions, this study used participants with a low level of pain intensity and had a majority still engaged in full-time employment. Our results found that people with persistent low-level pain demonstrate a reduction in performance compared with controls. Our study revealed that using a sensitive tool to detect minor performance deficits could indicate pain interference. The early detection of pain interference would provide an opportunity for prevention programs to have a pre-emptive effect on work-related musculoskeletal disorders.

[1]  R. Melzack The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[2]  T. Roth,et al.  Fragmenting sleep diminishes its recuperative value. , 1987, Sleep.

[3]  K. Wilson,et al.  Sleep in depressed and nondepressed participants with chronic low back pain: electroencephalographic and behaviour findings. , 2002, Sleep.

[4]  Walter Schneider,et al.  Controlled and Automatic Human Information Processing: 1. Detection, Search, and Attention. , 1977 .

[5]  J. Deutsch Perception and Communication , 1958, Nature.

[6]  G. Crombez,et al.  Attentional disruption is enhanced by the threat of pain. , 1998, Behaviour research and therapy.

[7]  Stephen J. Boies,et al.  Components of attention. , 1971 .

[8]  R. Jamison,et al.  The Influence of Problems with Concentration and Memory on Emotional Distress and Daily Activities in Chronic Pain Patients , 1989, International journal of psychiatry in medicine.

[9]  D. Zald,et al.  Cognitive Impairment in Musculoskeletal Pain Patients , 1991, International journal of psychiatry in medicine.

[10]  T. Hadjistavropoulos,et al.  Health anxiety moderates the effects of distraction versus attention to pain. , 2000, Behaviour research and therapy.

[11]  Frank Baeyens,et al.  When somatic information threatens, catastrophic thinking enhances attentional interference , 1998, Pain.

[12]  J. Strain,et al.  Benzodiazepine Use by Chronic Pain Patients , 1990, The Clinical journal of pain.

[13]  I. Pilowsky,et al.  Sleep disturbance in pain clinic patients , 1985, Pain.

[14]  T. Roth,et al.  Disturbed Sleep in Patients Complaining of Chronic Pain , 1982, The Journal of nervous and mental disease.

[15]  Alan D. Baddeley,et al.  A 3 min reasoning test based on grammatical transformation , 1968 .

[16]  David F. Dinges,et al.  Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations , 1985 .

[17]  C. Eccleston,et al.  Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. , 1995, Behaviour research and therapy.

[18]  H. Moldofsky,et al.  Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia. , 1997, The Journal of rheumatology.

[19]  G. Grace,et al.  Concentration and memory deficits in patients with fibromyalgia syndrome. , 1999, Journal of clinical and experimental neuropsychology.

[20]  T. Barber,et al.  Effects on Pain of Experimentally Induced and Spontaneous Distraction , 1972, Psychological reports.

[21]  T. Pincus,et al.  Do chronic pain patients 'Stroop' on pain stimuli? , 1998, British Journal of Clinical Psychology.

[22]  F. Watts,et al.  Description and measurement of concentration problems in depressed patients , 1985, Psychological Medicine.

[23]  Brian D. Dufton Cognitive Failure and Chronic Pain , 1990, International journal of psychiatry in medicine.

[24]  L. McCracken,et al.  The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain , 1992, Pain.

[25]  K. Wilson,et al.  Cognitive-behavioral treatment of insomnia secondary to chronic pain. , 2000, Journal of consulting and clinical psychology.

[26]  M. R. MacDonald,et al.  Memory Complaints in Chronic Pain , 1995, The Clinical journal of pain.

[27]  J. Turner,et al.  Self-report screening measures for depression in chronic pain patients. , 1984, Journal of clinical psychology.

[28]  D. Karasic,et al.  Anxiety and anxiety disorders. , 1996, Focus.

[29]  M. Eysenck Attention And Arousal, Cognition And Performance , 1982 .

[30]  A. M. Harvey Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms , 1995 .

[31]  J. Lorenz,et al.  Cognitive performance, mood and experimental pain before and during morphine-induced analgesia in patients with chronic non-malignant pain , 1997, Pain.

[32]  R. Shiffrin,et al.  Automatic and controlled processing revisited. , 1984, Psychological review.

[33]  P. Totterdell,et al.  On-shift and daily variations in self-report and performance measures in rotating-shift and permanent night nurses , 1995 .

[34]  G. Crombez,et al.  The disruptive nature of pain: an experimental investigation. , 1996, Behaviour research and therapy.

[35]  H. Babkoff,et al.  The effects of 72 hours of sleep loss on psychological variables. , 1989, British journal of psychology.

[36]  Timothy H. Monk,et al.  Circadian rhythms in human memory , 1980 .

[37]  Tim Shallice,et al.  Supervisory control of action and thought selection. , 1993 .

[38]  S. Sternberg Memory-scanning: mental processes revealed by reaction-time experiments. , 1969, American scientist.

[39]  D. Broadbent,et al.  The Cognitive Failures Questionnaire (CFQ) and its correlates. , 1982, The British journal of clinical psychology.

[40]  R T Wilkinson,et al.  Portable devices for measuring performance in the field: the effects of sleep deprivation and night shift on the performance of computer operators. , 1979, Ergonomics.

[41]  G. Bower Mood and memory. , 1981, The American psychologist.

[42]  M H Bonnet,et al.  Effect of sleep disruption on sleep, performance, and mood. , 1985, Sleep.

[43]  G. Robert J. Hockey,et al.  Cognitive-energetical control mechanisms in the management of work demands and psychological health. , 1993 .

[44]  G. Iverson,et al.  Predicting complaints of impaired cognitive functioning in patients with chronic pain. , 2001, Journal of pain and symptom management.

[45]  Keith G Wilson,et al.  Daily diary and ambulatory activity monitoring of sleep in patients with insomnia associated with chronic musculoskeletal pain , 1998, Pain.

[46]  R. Heslegrave,et al.  The effects of task duration and work-session location on performance degradation induced by sleep loss and sustained cognitive work , 1985 .

[47]  M. Cousins International association for the study of pain , 1989, Pain.

[48]  C Trenkwalder,et al.  New actigraphic assessment method for periodic leg movements (PLM). , 1995, Sleep.

[49]  C. Eccleston The attentional control of pain: methodological and theoretical concerns , 1995, Pain.

[50]  P. Sjøgren,et al.  Neuropsychological performance in cancer patients: the role of oral opioids, pain and performance status , 2000, Pain.

[51]  P. Lavie,et al.  Actigraphic measurements of sleep in rheumatoid arthritis: comparison of patients with low back pain and healthy controls. , 1992, The Journal of rheumatology.

[52]  Yu-Pin Hsu,et al.  Understanding Work-Related Upper Extremity Disorders: Clinical Findings in 485 Computer Users, Musicians, and Others , 2001, Journal of Occupational Rehabilitation.

[53]  Martin Rivers,et al.  A program for studies of altered sleep-wake schedules and performance , 1994 .

[54]  D F Kripke,et al.  Wrist-actigraphic estimation of sleep time. , 1980, Sleep.

[55]  S. Passik,et al.  Patient-related barriers to pain management in ambulatory AIDS patients , 1998, Pain.

[56]  M. Zeegers,et al.  The modified Stroop paradigm as a measure of selective attention towards pain‐related stimuli among chronic pain patients: a meta‐analysis , 2002, European journal of pain.

[57]  Robert T. Wilkinson,et al.  Portable four-choice reaction time test with magnetic tape memory , 1975 .

[58]  F. Craik,et al.  The effects of divided attention on encoding and retrieval processes in human memory. , 1996, Journal of experimental psychology. General.

[59]  Cognitive-processing bias in chronic pain: a review and integration. , 2001, Psychological bulletin.

[60]  M. Klinger,et al.  The effect of headache pain on attention (encoding) and memory (recognition) , 2002, Pain.

[61]  D. Greenblatt,et al.  Chronic Treatment with Fluvoxamine, Clovoxamine, and Placebo: Interaction with Digoxin and Effects on Sleep and Alertness , 1989, Journal of clinical pharmacology.

[62]  K. Mccaul,et al.  Distraction and coping with pain. , 1984, Psychological bulletin.

[63]  P. Hauri,et al.  Wrist actigraphy in insomnia. , 1992, Sleep.

[64]  J Grigsby,et al.  Chronic pain is associated with deficits in information processing. , 1995, Perceptual and motor skills.

[65]  J. Stradling,et al.  Sleep fragmentation indices as predictors of daytime sleepiness and nCPAP response in obstructive sleep apnea. , 1998, American journal of respiratory and critical care medicine.

[66]  B. Bernard,et al.  Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back , 1997 .

[67]  R. Rosa,et al.  Recovery of performance during sleep following sleep deprivation. , 1983, Psychophysiology.

[68]  Amanda C.C. Williams,et al.  What does the BDI measure in chronic pain? , 1993, Pain.

[69]  I. Most Psychosocial elements in the work environment of a large call center operation. , 1999, Occupational medicine.

[70]  Cognitive performance and muscle activation in workers with chronic shoulder myalgia , 2001, Ergonomics.

[71]  Simon Folkard,et al.  Shiftwork effects in nuclear power workers : a field study using portable computers , 1995 .

[72]  L. McCracken Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain , 1998, Pain.

[73]  L. McCracken,et al.  The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments. , 1996, Behaviour research and therapy.

[74]  J. Mocco,et al.  Severe pain confounds neuropsychological test performance. , 2000, Journal of clinical and experimental neuropsychology.

[75]  B Bromm,et al.  Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome. , 1996, Electroencephalography and clinical neurophysiology.