An empirical evaluation of the latent structure of cognitive analgesia strategies

Factors influencing the effectiveness of cognitive strategies for analgesia were assessed using a cold pressor pain task with 96 subjects. Subjects rated pain during baseline and post-treatment exposures to the ice water pain stimulus. Between trials, subjects in four groups were trained in the use of a cognitive coping strategy. Training consisted of brief practice in strategies involving: a) imaginal reinterpretation of the pain stimulus, b) imaginal distraction from the pain stimulus, c) non-imaginal reinterpretation, or d) non-imaginal distraction. Two additional groups were given: e) a suggestion to expect analgesia but no coping strategy, or f) no treatment (i.e., equivalent waiting period only). Subjects also rated their expectancy for post-treatment pain immediately before and after training. Administration of the four coping strategies resulted in equivalent attenuation of pain ratings during the posttraining trial. Subjects in these four groups also reported equivalent expectancies for analgesia. Subjects in the expectancy control group expected analgesia, but reported no significant change in pain rating from baseline to the posttreatment trial. No treatment control group subjects neither expected nor achieved any significant change in their pain ratings. Regression of expectancy scores and posttest scores for absorption in cognitive strategies on pain reduction scores demonstrated that expectancy and absorption in the cognitive strategies both contributed significantly to reported pain reduction. In addition, scores for expectancy and for absorption in the cognitive strategies correlated significantly with each other. These findings are contrary to accounts of cognitive analgesia which have attributed the effectiveness of cognitive strategies solely to expectancy. The data suggests that expectancy is a necessary, but not sufficient condition for analgesia. Expectancy may interact with the extent to which a subject utilizes a cognitive coping strategy, thereby influencing the effectiveness of that strategy. Strategy enactment is also a critical factor, but there are no overall differences in the effectiveness of strategies which differ in terms of imagery or degree of sensation acknowledgement.