Impulsivity and pain attentional bias in veterans receiving care for chronic non-malignant pain

Front Pain Res (Lausanne). 2026 Apr 23;7:1652567. doi: 10.3389/fpain.2026.1652567. eCollection 2026.

ABSTRACT

INTRODUCTION: A prevailing biopsychosocial model of chronic non-malignant pain (CNMP) includes psychological drivers of disability such as pain catastrophizing or negative mood symptomatology, such that preoccupation with pain or pain signals might be manifested at even the subconscious level and could also interact with trait impulsivity to prioritize immediate relief using opioids over safer pain management strategies. However, studies of impulsivity and cognitive biases in CNMP have often not controlled for current opioid use. Moreover, despite the ubiquity of CNMP in military veterans, pain attentional bias in veterans has not been explored.

METHODS: We administered computerized tasks to probe attentional capture by visual pain-related stimuli in signal detection tasks, myopic delay-discounting behavior and general symptomatology in n = 61 veterans who were receiving Veterans Health Administration (VHA) care for CNMP (CNMP Group) with no histories of chronic opioid use and in n = 38 veterans who reported no CNMP (Controls).

RESULTS: We replicated in veterans previous findings of significantly greater depression and anxiety and higher levels of pain-related disability and kinesiophobia, lower quality of life, and more severe delay discounting than Controls. However, the CNMP group did not show greater motoric impulsivity, nor greater attentional capture by distress-related visual stimuli or frustration tolerance in other tasks. Follow-up analyses indicated that across all participants, individual differences in attentional bias toward pain also did not relate to scores on a latent factor of mood and pain-related symptomatology. In contrast, psychological distress correlated positively with motoric impulsivity in a stop-signal task, specifically under conditions with a pain-related visual distractor, and high values of a negative mood factor showed a trend toward a correlation with more severe discounting of delayed rewards.

DISCUSSION: These data extend to veterans previous findings of greater psychological distress and delay discounting in adults with CNMP but offer only modest evidence that persons with CNMP who do not manage pain with opioids show increased attentional capture by pain-related visual stimuli.

PMID:42110389 | PMC:PMC13149377 | DOI:10.3389/fpain.2026.1652567