Extinction of Fear Generalization: A Comparison Between Fibromyalgia Patients and Healthy Control Participants

Meulders, Ann; Meulders, Michel; Stouten, Iris; Bie, Jozef De; Vlaeyen, Johan W.S.

doi:10.1016/j.jpain.2016.10.004

Cited by 55 publications

(61 citation statements)

References 53 publications

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“…Moreover, in patients with irritable bowel syndrome (IBS) compared to healthy individuals, increased cerebellar responses to both pain-associated and safety conditioned stimuli (CSs) during fear learning have been found. With respect to fear extinction, chronic pain may be characterized by impaired extinction of pain-related fear generalization [ 84 ] and enhanced reactivations of extinguished conditioned fear responses [ 85 – 87 ]. This may indicate a preservation of pain disability in chronic pain by persistent excessive protective behavior, which seems to be related to an individual's awareness of the association between the CS and the pain, which is the unconditioned stimulus [ 88 , 89 ].…”

Section: Human Studies To Investigate An Emotional-motivational Shmentioning

confidence: 99%

Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

Becker

Navratilova

Nees

et al. 2018

Pain Research and Management

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Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.

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Section: Human Studies To Investigate An Emotional-motivational Shmentioning

confidence: 99%

Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

Becker

Navratilova

Nees

et al. 2018

Pain Research and Management

View full text Add to dashboard Cite

show abstract

“…Impaired extinction efficacy hence implies a latent vulnerability for fear memory reactivation and relapse. Indeed, impaired extinction efficacy of maladaptive pain-related fear and safety responses, including reinstatement of pain-related fear, has already been observed in patients with chronic pain (Icenhour et al, 2015b;Labus et al, 2013;Meulders et al, 2017;Schneider et al, 2004), which would fit within but also considerably extend the fear-avoidance model of pain. This is not only conceptually intriguing, yet calls for experimental studies to further elucidate the formation and especially the extinction of pain-related fear and safety learning in a clinically relevant context.…”

Section: Extinction and Beyondmentioning

confidence: 92%

From gut feelings to memories of visceral pain

et al. 2020

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The role of pain-related fear learning and memory processes, conceptually embedded within the fear-avoidance model of chronic pain, is increasingly recognized. The unique biological salience of interoceptive, visceral pain with its cognitive, emotional, and motivational facets fosters associative learning. Conditioned fear is in principle adaptive but may turn maladaptive and contribute to hypervigilance and hyperalgesia in chronic pain. This review summarizes current knowledge on the formation, extinction, and return of pain-related memories with a focus on visceral pain. It provides a conceptual background, describes experimental approaches, and summarizes findings on behavioral and neural mechanisms in healthy humans and patients with chronic pain. Future directions underscore the potential of refining knowledge on the role of associative learning in the pathophysiology and treatment of chronic visceral pain in disorders of gut–brain interactions such as irritable bowel syndrome.

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“…Differential fear learning has been reported to be altered in chronic pain populations [17,18,52]. Klinger, Matter [25], for instance, reported increased conditioned responses in tensiontype headache patients as compared to healthy controls.…”

Section: Implications For Chronic Pain Populationsmentioning

confidence: 99%

“…the retrieval of an extinguished memory after an unexpected exposure to the US [13,14]. These learning processes have been thoroughly investigated for fear-learning in anxiety disorders [15], but only recently has research started to study pain-related learning mechanisms in experimental and chronic pain (e.g., [16][17][18]) suggesting enhanced conditioned pain-related fear, impaired differential learning, and increased fear generalization of CS in chronic pain. There are only few studies examining painrelated spontaneous recovery [19] or reinstatement of previously extinguished CR reporting inconclusive findings.…”

Section: Introductionmentioning

confidence: 99%

Enhanced pain-related conditioning for face compared to hand pain

et al. 2020

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Pain is evolutionarily hardwired to signal potential danger and threat. It has been proposed that altered pain-related associative learning processes, i.e., emotional or fear conditioning, might contribute to the development and maintenance of chronic pain. Pain in or near the face plays a special role in pain perception and processing, especially with regard to increased pain-related fear and unpleasantness. However, differences in pain-related learning mechanisms between the face and other body parts have not yet been investigated. Here, we examined body-site specific differences in associative emotional conditioning using electrical stimuli applied to the face and the hand. Acquisition, extinction, and reinstatement of cue-pain associations were assessed in a 2-day emotional conditioning paradigm using a within-subject design. Data of 34 healthy subjects revealed higher fear of face pain as compared to hand pain. During acquisition, face pain (as compared to hand pain) led to a steeper increase in pain-related negative emotions in response to conditioned stimuli (CS) as assessed using valence ratings. While no significant differences between both conditions were observed during the extinction phase, a reinstatement effect for face but not for hand pain was revealed on the descriptive level and contingency awareness was higher for face pain compared to hand pain. Our results indicate a stronger propensity to acquire cue-pain-associations for face compared to hand pain, which might also be reinstated more easily. These differences in learning and resultant pain-related emotions might play an important role in the chronification and high prevalence of chronic facial pain and stress the evolutionary significance of pain in the head and face.

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Extinction of Fear Generalization: A Comparison Between Fibromyalgia Patients and Healthy Control Participants

Cited by 55 publications

References 53 publications

Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

From gut feelings to memories of visceral pain

Enhanced pain-related conditioning for face compared to hand pain

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