Chronic Pain and Emotional Stroop: A Systematic Review

Chronic pain is an unpleasant sensory and emotional experience that persists for more than 3 months and is often accompanied by symptoms such as depression, fatigue, sleep disturbances, and cognitive impairment. Emotional dysregulation may also be involved in its etiology. Emotions are known to modulate the experience of pain by influencing cognition and behavior (emotional awareness, emotional expression and experience, and verbalizations). A useful task to explore emotional processing and emotional dysregulation is the emotional Stroop task. Despite the large number of studies using this task, their objectives are diverse; it is necessary to integrate them. The main objective of the present systematic review was to determine the extent of the abnormalities in behavioral performance (including attentional biases) and/or brain alterations in patients with chronic pain during the emotional Stroop task. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The protocol was previously registered in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were extracted from the PubMed, Scopus, and Web of Science databases. Fifteen studies were identified as eligible for systematic review. The studies reported alterations in brain regions related to pain and emotional regulation, as well as attentional bias and higher response time latencies (related to the words' emotional load) in patients with chronic pain. The results confirm the validity of the emotional Stroop task to measure emotions and selective attention. As attentional bias towards negative information is often seen in chronic pain patients, and given the relation between selective attention and greater activation of the brain areas associated with pain and emotional processing, this type of task plays a crucial role in research on emotional and attentional processes among chronic pain patients. Further, attentional bias towards negative information has been associated with higher levels of pain. Taken together, the results suggest the need for cognitive training and an emotional approach to chronic pain therapies, especially targeting attentional biases and negative mood.