The present experiment examined the possibility to change the sensory and/or the affective perception of thermal stimuli by an emotional associative learning procedure known to operate without participants' awareness (evaluative conditioning). In a mixed design, an aversive conditioning procedure was compared between subjects to an appetitive conditioning procedure. Both groups were also compared within-subject to a control condition (neutral conditioning). The aversive conditioning was induced by associating non-painful and painful thermal stimuli - delivered on the right forearm - with unpleasant slides. The appetitive conditioning consisted in an association between thermal stimuli - also delivered on the right forearm - and pleasant slides. The control condition consisted in an association between thermal stimuli - delivered for all participants on the left forearm - and neutral slides. The effects of the conditioning procedures on the sensory and affective dimensions were evaluated with visual analogue scale (VAS)-intensity and VAS-unpleasantness. Startle reflex was used as a physiological index of emotional valence disposition. Results confirmed that no participants were aware of the conditioning procedure. After unpleasant slides (aversive conditioning), non-painful and painful thermal stimuli were judged more intense and more unpleasant than when preceded by neutral slides (control condition) or pleasant slides (appetitive conditioning). Despite a strong correlation between the intensity and the unpleasantness scales, effects were weaker for the affective scale and, became statistically non-significant when VAS-intensity was used as covariate. This experiment shows that it is possible to modify the perception of intensity of thermal stimuli by a non-conscious learning procedure based on the transfer of the valence of the unconditioned stimuli (pleasant or unpleasant slides) towards the conditioned stimuli (non-painful and painful thermal stimuli). These results plead for a conception of pain as a conscious output of complex informational processes all of which are not accessible to participants' awareness. Mechanisms by which affective input may influence sensory experience and clinical implications of the present study are discussed.

An association between mental disorders, musculoskeletal and cardiovascular diseases has been reported in many clinical studies with inpatients. However, no data exist about the prevalence of mental disorders in patients undergoing rehabilitation treatment for musculoskeletal and cardiovascular diseases. The present study investigates 4-week, 12-month and lifetime prevalence rates of comorbid mental disorders in more than 1700 patients out of 10 rehabilitation clinics. The patients were screened (GHQ-12, HADS) in the context of a two-stage epidemiological survey. In the second-stage examination a subsample of 369 patients was interviewed with a standardized clinical interview (CIDI) in order to obtain DSM-IV and ICD-10 diagnoses of mental disorders. 43 % (musculoskeletal) and 36 % (cardiovascular) of the patients have high GHQ-scores (cut off > 4). Furthermore, up to 24 % of the musculoskeletal and cardiovascular patients have elevated scores on the HADS subscales depression and anxiety (cut off > 10). For the 4-week period, prevalence rates of mental disorders in the sample of patients with musculoskeletal diseases are 31 % and 20 % in the sample of patients with cardiovascular diseases. The most frequent current disorders are affective and anxiety disorders. The high psychosocial burden expressed by the patients and the prevalence of depressive and anxiety disorders emphasize the importance of (1) effective diagnostic strategies to recognize mental disorders, (2) specialized psychological services in rehabilitation clinics, which provide psychological support and effective interventions for patients with musculoskeletal and cardiovascular diseases.

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