Classical Conditioning Differences Associated With Chronic Pain: A Systematic Review

Harvie, Daniel S.; Moseley, G. Lorimer; Hillier, Susan; Meulders, Ann

doi:10.1016/j.jpain.2017.02.430

Cited by 62 publications

(64 citation statements)

References 45 publications

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“…It serves to rapidly shift attention toward signals of threat in order to avoid bodily harm, engage in self-protection and seek safety. Although adaptive by nature, fear and ensuing avoidance behaviors can also become maladaptive, with broad implications for the pathophysiology and treatment of chronic pain (1,2). The fear-avoidance model of pain proposes a vicious cycle of pain-related fear, hypervigilance and avoidance, maintained, and modulated by psychological vulnerability factors like anxiety, catastrophizing, and negative affect (3,4).…”

Section: Introductionmentioning

confidence: 99%

Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model

2020

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Although the broad role of fear and hypervigilance in conditions of the gut-brain axis like irritable bowel syndrome is supported by converging evidence, the underlying mechanisms remain incompletely understood. Even in healthy individuals, it remains unclear how pain-related fear may contribute to pain-related attentional biases for acute visceral pain. Building on our classical fear conditioning work in a clinically relevant model of visceral pain, we herein elucidated pain-related attentional biases shaped by associative learning in healthy women and men, aiming to elucidate possible sex differences and the role of psychological traits. To this end, we compared the impact of differentially conditioned pain-predictive cues on attentional biases in healthy women and men. Sixty-four volunteers accomplished a visual dot-probe task and subsequently underwent pain-related fear conditioning where one visual cue (CS + ) was contingently paired with a painful rectal distention (US) while another cue remained unpaired (CS − ). During the following test phase, the dot-probe task was repeated to investigate changes in attentional biases in response to differentially valenced cues. While pain-related learning was comparable between groups, men revealed more pronounced attentional engagement with the CS + and CS − whereas women demonstrated stronger difficulties to disengage from the CS + when presented with a neutral cue. However, when both CS + and CS − were presented together, women revealed stronger difficulties to disengage from the CS − . Regression analyses revealed an interaction of sex, with negative affect predicting stronger avoidance of the CS + and stronger difficulties to disengage attention from the CS − in men. These results provide first evidence that pain-related fear conditioning may induce attentional biases differentially in healthy women and men. Hence, sex differences may play a role in attentional mechanisms underlying hypervigilance, and may be modulated by psychological vulnerability factors relevant to chronic visceral pain.

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Section: Introductionmentioning

confidence: 99%

Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model

2020

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“…As an evolutionarily well-conserved process, generalization enables safe and efficient navigation of a complex and multidimensional world ( Sutton and Barto, 1998 ; Ghirlanda and Enquist, 2003 ). However, over- generalization, resulting in inappropriate avoidance of safe stimuli, actions or contexts, has been suggested as a possible pathological mechanism in a range of psychological disorders including anxiety, chronic pain, and depression ( Duits et al, 2015 ; Dymond et al, 2015 ; Vlaeyen and Linton, 2012 ; Harvie et al, 2017 ; Pearson et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Value generalization in human avoidance learning

Norbury

Robbins

Seymour

2018

eLife

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Generalization during aversive decision-making allows us to avoid a broad range of potential threats following experience with a limited set of exemplars. However, over-generalization, resulting in excessive and inappropriate avoidance, has been implicated in a variety of psychological disorders. Here, we use reinforcement learning modelling to dissect out different contributions to the generalization of instrumental avoidance in two groups of human volunteers (N = 26, N = 482). We found that generalization of avoidance could be parsed into perceptual and value-based processes, and further, that value-based generalization could be subdivided into that relating to aversive and neutral feedback − with corresponding circuits including primary sensory cortex, anterior insula, amygdala and ventromedial prefrontal cortex. Further, generalization from aversive, but not neutral, feedback was associated with self-reported anxiety and intrusive thoughts. These results reveal a set of distinct mechanisms that mediate generalization in avoidance learning, and show how specific individual differences within them can yield anxiety.

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“…Previous studies have suggested that 1) pain-related fear and avoidance appear to be essential features of the development of a chronic pain state in patients with musculoskeletal pain, 21 – 29 and 2) fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and may interact with the experience of pain. 30 , 31 These studies suggest that it is very important to decrease fear-avoidance beliefs and pain catastrophizing to improve the QOL of patients with chronic musculoskeletal pain.…”

Section: Discussionmentioning

confidence: 99%

Development and implementation of an inpatient multidisciplinary pain management program for patients with intractable chronic musculoskeletal pain in Japan: preliminary report

Takahashi

Kasahara

Yabuki

2018

JPR

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IntroductionMultidisciplinary pain management is a useful method to treat chronic musculoskeletal pain. Few facilities in Japan administer a multidisciplinary pain management program, especially an inpatient program. Therefore, we implemented a multidisciplinary pain management program in our hospital based on biopsychosocial factors guided by the recommendations of the International Association for the Study of Pain. The purpose of this study is to describe our inpatient pain management program for Japanese patients, which uses the biopsychosocial method of pain self-management.Materials and methodsFourteen patients with intractable chronic musculoskeletal pain, who were implemented a multidisciplinary pain management program in our hospital, were studied using the evaluation of the pain and associated factors and physical function.ResultsSignificant improvement in outcomes were seen in the brief pain inventory, the pain catastrophizing scale (rumination, magnification, and helplessness), the pain disability assessment scale, the hospital anxiety and depression scale (anxiety and depression), the pain self-efficacy questionnaire, the EuroQol five dimensions questionnaire, and muscle endurance and physical fitness. We found no statistically significant differences in static flexibility or walking ability.ConclusionWe developed an inpatient chronic pain management program for Japanese patients. Our results suggest that our program improves chronic musculoskeletal pain coping mechanisms, and that the program can improve patients’ quality of life and some physical function. This inpatient pain management program is being expanded to better help intractable chronic musculoskeletal pain patients.

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Classical Conditioning Differences Associated With Chronic Pain: A Systematic Review

Cited by 62 publications

References 45 publications

Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model

Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model

Value generalization in human avoidance learning

Development and implementation of an inpatient multidisciplinary pain management program for patients with intractable chronic musculoskeletal pain in Japan: preliminary report

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