Eye Gaze Markers Indicate Visual Attention to Threatening Images in Individuals with Chronic Back Pain

Research into attentional biases and threatening, pain-related information has primarily been investigated using reaction time as the dependent variable. This study aimed to extend previous research to provide a more in depth investigation of chronic back pain and individuals’ attention to emotional stimuli by recording eye movement behavior. Individuals with chronic back pain (n = 18) were recruited from a back rehabilitation program and age and sex matched against 17 non-symptomatic controls. Participants’ eye movements were recorded whilst they completed a dot probe task, which included back pain specific threatening images and neutral images. There were no significant differences between chronic pain and control participants in attentional biases recorded using reaction time from the dot probe task. Chronic pain participants, however, demonstrated a significantly higher percentage of fixations, larger pupil diameter, a longer average fixation duration and faster first fixation to threatening compared to neutral images. They also had a significantly longer average fixation duration and larger pupil diameter to threatening images compared to control participants. The findings of this study suggest eye gaze metrics may provide a more sensitive measure of attentional biases in chronic pain populations. These findings may have important therapeutic implications for the patient and therapist.