Abstract
Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.
Zusammenfassung: Im Rahmen dieser Untersuchung wurde überprüft, ob chronische ambulant behandelte Schmerzpatienten unter generellen oder speziellen Aufmerksamkeitsdefiziten leiden. Zur Überprüfung der unterschiedlichen Teilaspekte der Aufmerksamkeit kam die “Testbatterie zur Aufmerksamkeitsprüfung” (TAP) zur Anwendung. Mit diesem Test werden basale (Aufmerksamkeitsaktivierung und Vigilanz) und komplexe Aufmerksamkeitsleistungen (selektive, geteilte und verdeckte Aufmerksamkeit, visuelle Suche und Go-NoGo-Entscheidungen) getestet. Vierundzwanzig chronisch ambulant behandelte Schmerzpatienten und 24 im Hinblick auf Alter, Geschlecht und Ausbildung parallelisierte Kontrollpersonen wurden mit dieser Testbatterie untersucht. Insgesamt zeigt sich, dass die Schmerzpatienten praktisch in allen Aufmerksamkeitsbereichen erhebliche Defizite aufweisen. Nur bei der Bearbeitung des relativ anspruchsvollen Tests zur geteilten Aufmerksamkeit erzielen Patienten mit chronischem Schmerz unauffällige Ergebnisse. Es wird vermutet, dass diese komplexe Aufmerksamkeitsleistung einen “ablenkenden” Einfluss auf die Schmerzwahrnehmung ausübt, so dass die Patienten mit größerer Konzentration die Aufmerksamkeitsaufgabe durchführen können. Diese Befunde legen nahe, dass chronische Schmerzpatienten auch im Hinblick auf kognitive Leistungen und insbesondere auf Aufmerksamkeitsdefizite untersucht werden müssen. Die Offenlegung von Aufmerksamkeitsdefiziten bei dieser Patientengruppe kann eine große Bedeutung im Zusammenhang mit Renten- und Versicherungsfragen haben. Darüber hinaus belegt der Befund bzgl. der geteilten Aufmerksamkeit erneut, dass eine Ablenkung vom Schmerz positive therapeutische Effekte haben kann.
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