Attention focus, trait anxiety and pain perception in patients undergoing colposcopy

Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction and undirected control. Psychometric measures of pre-colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self-reported pain intensity, sensory pain and affective pain did not differ across groups. Further, there were no significant between-group differences in colposcopy-related state anxiety or affect. However, pre-colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain.