Fear in the context of pain: Lessons learned from 100 years of fear conditioning research

Meulders, Ann

doi:10.1016/j.brat.2020.103635

Cited by 116 publications

(151 citation statements)

References 182 publications

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“…The subject may experience their body as vulnerable and become more socially isolated: factors that in turn may promote the persistence of pain. In chronic pain, patients show impairment in safety learning, even in light of disconfirmatory evidence, as well as an excessive overgeneralization of negative emotions and avoidance behavior further restricting mobility (Meulders, 2019(Meulders, , 2020Vlaeyen & Crombez, 2020). This aligns with current evidence suggesting that fear and Fig.…”

Section: Dynamic Questionsupporting

confidence: 79%

Pain and the field of affordances: an enactive approach to acute and chronic pain

Coninx

Stilwell

2021

Synthese

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In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification.

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Section: Dynamic Questionsupporting

confidence: 79%

Pain and the field of affordances: an enactive approach to acute and chronic pain

Coninx

Stilwell

2021

Synthese

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“…Human fear conditioning studies with experimental pain as unconditioned stimuli (US) have implemented exteroceptive, somatic 16 – 19 or interoceptive, visceral pain as salient threats 20 – 23 , but knowledge about common and distinct threat-specific neural mechanisms remains limited, especially regarding the extinction and retrieval of pain-related fear memories 24 , 25 . Combining interoceptive and exteroceptive threats from different sensory modalities, as accomplished herein, constitutes a unique opportunity to elucidate specificity to threat modality in a clinically-relevant context 4 , 26 , and is timely given recent conceptual advances regarding interoception 27 , 28 and interoceptive psychopathology 29 .…”

Section: Introductionmentioning

confidence: 99%

Associative learning and extinction of conditioned threat predictors across sensory modalities

et al. 2021

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The formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.

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“…In the context of physical exercise and within models of fear of movement (17), pain catastrophizing has been repeatedly associated with more severe symptomatology and a poorer adaptation to bromyalgia (18,19). Pain catastrophizing is a highly prevalent coping strategy among bromyalgia patients (20,21) characterized by a pessimistic and exaggerated interpretation of current or anticipated pain sensations (22).…”

Section: Introductionmentioning

confidence: 99%

“…Pain catastrophizing is a highly prevalent coping strategy among bromyalgia patients (20,21) characterized by a pessimistic and exaggerated interpretation of current or anticipated pain sensations (22). This biased interpretation of events is what has been argued to lead to avoidance of movement and, ultimately, to poor overall physical status (17). Interestingly, however, the relationship between pain catastrophizing and fatigue is not well established in bromyalgia (23)(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

The Role of Catastrophizing in the Benefits of Walking on Fatigue in Women with Fibromyalgia

Sanromán

Catalá

Écija

et al. 2021

Preprint

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Background Walking is one of the most beneficial treatments for fibromyalgia patients. On the other hand, pain catastrophizing is one of the main cognitive processes that these patients present. However, it is not known how this process may affect the relationship between walking and fatigue. Therefore our goal is to analyze the associations between fatigue, catastrophizing, and walking in fibromyalgia patients, and to explore the moderation effect of walking in the association between catastrophizing and fatigue. Methods A cross-sectional study was carried out with 234 women with fibromyalgia older than 18 years. We use Multidimensional Fatigue Inventory for asses fatigue and Pain Catastrophizing Scale for pain catastrophizing (differentiating between its three dimensions, namely rumination, magnification, and helplessness). An ad-hoc self-reported item was used to evaluate walking. We perform the moderation analyses with walking as moderator. Results Walking moderated the relationship between rumination and fatigue (Beta = 0.21 t = 2.24, p = 0.26) and that of magnification with fatigue (Beta = 0.26, t = 2.1, p = .036). Specifically, that rumination and magnification only contributed to more fatigue when patients engaged in walking behavior. Helplessness contributed to more fatigue independently of adherence to walking (Beta = 0.12, t = 2.1, p = .036). Conclusions Patients who did not walk were highly fatigued irrespective of their cognitive profile (rumination and magnification only contributed to fatigue when patients walked). Therefore, in the field of personalized treatments, different recommendations should be provided about fatigue management in implementing walking and in its maintenance in the long term in fibromyalgia patients.

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Fear in the context of pain: Lessons learned from 100 years of fear conditioning research

Cited by 116 publications

References 182 publications

Pain and the field of affordances: an enactive approach to acute and chronic pain

Pain and the field of affordances: an enactive approach to acute and chronic pain

Associative learning and extinction of conditioned threat predictors across sensory modalities

The Role of Catastrophizing in the Benefits of Walking on Fatigue in Women with Fibromyalgia

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