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Luebke L, Lopes CG, Myka Y, Lumma A, Adamczyk WM, Carvalho GF, Scholten-Peeters GGM, Luedtke K, Szikszay TM. Assessing the Influence of Nonischemic A-Fiber Conduction Blockade on Offset Analgesia: An Experimental Study. THE JOURNAL OF PAIN 2024:104611. [PMID: 38908497 DOI: 10.1016/j.jpain.2024.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
Offset analgesia (OA) is believed to reflect the efficiency of the endogenous pain modulatory system. However, the underlying mechanisms are still being debated. Previous research suggested both, central and peripheral mechanisms, with the latter involving the influence of specific A-delta-fibers. Therefore, this study aimed to investigate the influence of a nonischemic A-fiber conduction blockade on the OA response in healthy participants. A total of 52 participants were recruited for an A-fiber conduction blockade via compression of the superficial radial nerve. To monitor fiber-specific peripheral nerve conduction capacity, quantitative sensory testing was performed continuously. Before, during, and after the A-fiber block, an individualized OA paradigm was applied to the dorsum of both hands (blocked and control sides were randomized). The pain intensity of each heat stimulus was evaluated by an electronic visual analog scale. A successful A-fiber conduction blockade was achieved in thirty participants. OA has been verified within time (before, during, and after blockade) and condition (blocked and control side) (P < .01, d > .5). Repeated measurements analysis of variance showed no significant interaction effects between OA within condition and time (P = .24, η²p = .05). Hence, no significant effect of A-fiber blockade was detected on OA during noxious heat stimulation. The results suggest that peripheral A-fiber afferents may play a minor role in OA compared with alternative central mechanisms or other fibers. However, further studies are needed to substantiate a central rather than peripheral influence on OA. PERSPECTIVE: This article presents the observation of OA before, during, and after a successful A-fiber conduction blockade in healthy volunteers. A better understanding of the mechanisms of OA and endogenous pain modulation, in general, may help to explain the underlying aspects of pain disorders.
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Affiliation(s)
- Luisa Luebke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany.
| | - Clara Gieseke Lopes
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Yasmin Myka
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany
| | - Annika Lumma
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany
| | - Wacław M Adamczyk
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany; Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
| | - Tibor M Szikszay
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Lübeck, Germany
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2
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Gatzounis R, Gelissen A, Theuerzeit D, Meulders A. Rewarding Approach Behaviour Attenuates the Return of Pain-Related Avoidance After Successful Extinction with Response Prevention. THE JOURNAL OF PAIN 2024; 25:104453. [PMID: 38145858 DOI: 10.1016/j.jpain.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
After successful exposure treatment for chronic pain, pain-related fear and avoidance may return, i.e., relapse may occur. This return of fear and avoidance may be modulated by various post-treatment factors. In this study, we aimed to investigate two potential factors that may affect return of fear and avoidance, i.e. cognitive load and rewarding approach behaviour. In an operant pain-related avoidance conditioning paradigm, healthy pain-free volunteers first learned to fear and avoid an arm-reaching movement that was often paired with painful electrocutaneous stimulation (T1), by performing alternative movements that were less often (T2) or never (T3) paired with pain. During extinction with response prevention, participants were only allowed to perform T1, and pain was omitted. To model relapse, two unexpected painful stimuli were presented (i.e., reinstatement manipulation), after which participants could freely choose among the three arm-reaching movements again. During test, the Low Load group performed an additional easy digit task, whereas the High Load group performed a more cognitively demanding digit task. The Reward group performed the demanding digit task, whilst being rewarded to perform T1. Results showed that pain-related fear and avoidance returned, irrespective of cognitive load imposed. When participants were rewarded to approach T1, however, the return of avoidance, but not fear, was attenuated. Our findings suggest that engaging in rewarding activities may facilitate the maintenance of treatment outcomes, and provide additional support to the growing body of literature indicating a divergent relationship between fear and avoidance. PERSPECTIVE: Results of this experiment suggest that engaging in rewarding activities may optimize exposure treatment for chronic pain, by dampening the return of pain-related avoidance - though not of pain-related fear - after extinction.
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Affiliation(s)
- Rena Gatzounis
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anouk Gelissen
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Daniëlla Theuerzeit
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands; Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium.
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Krypotos AM, Sjouwerman R, Teppers M, Vlaeyen JWS. Pavlovian-to-instrumental transfer in individuals with chronic pain. Behav Res Ther 2024; 176:104491. [PMID: 38452688 DOI: 10.1016/j.brat.2024.104491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
Avoidance of pain has been argued to be key factor leading pain events to chronic disability. In this respect, research has focused on investigating the working mechanisms of avoidance's acquisition. Avoidance of painful stimuli has been traditionally studied using a combination of Pavlovian and Instrumental procedures. However, such approach seems to go against real-life scenarios where avoidance is commonly acquired more readily. Using a novel pain avoidance paradigm, we tested whether pain avoidance can be installed in absence of associations between a cue and pain omission, and whether such avoidance differs between pain patients and healthy controls. Participants first learned to avoid painful stimuli by pressing a grip bar. Then, they passively encountered pairings of one geometrical shape with pain and of another geometrical shape without pain. Lastly, participants encountered the geometrical shapes while being able to use the grip bar. Results showed that participants pressed the bar more vigorously when encountering the previously pain-related shape compared to the pain-unrelated shape. This effect did not seem to differ between pain patients and healthy control. Our study could inspire a new way in measuring avoidance in pain, possibly paving the way to better understanding how avoidance is installed in chronic pain.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Research Group of Healthy Psychology, KU Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Netherlands.
| | | | - Mathijs Teppers
- Ziekenhuis Oost-Limburg, Lanaken, Belgium; TRACE (Centre for Translational Psychological Research), Belgium
| | - Johan W S Vlaeyen
- Research Group of Healthy Psychology, KU Leuven, Belgium; Experimental Health Psychology, Maastricht University, Netherlands
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Meulders A, Traxler J, Vandael K, Scheepers S. High-Anxious People Generalize Costly Pain-Related Avoidance Behavior More to Novel Safe Contexts Compared to Low-Anxious People. THE JOURNAL OF PAIN 2024; 25:702-714. [PMID: 37832901 DOI: 10.1016/j.jpain.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/01/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
Pain-related avoidance is adaptive when there is a bodily threat, but when it generalizes to safe movements/situations, it may become disabling. Both subclinical anxiety-a vulnerability marker for chronic pain-and chronic pain are associated with excessive fear generalization to safe stimuli/situations. Previous research focused mainly on passive fear correlates (psychophysiological arousal and self-reports) leaving avoidance behavior poorly understood. Therefore, we tested whether high-anxious individuals generalize their pain-related avoidance behavior more to novel, safe contexts than low-anxious people. In a robotic-arm-reaching task, both groups (low vs high trait anxiety) performed 1 of 3 movements to reach a target. In the threat context (black background), a painful stimulus could be partly/completely prevented by performing more effortful trajectories (longer and more force needed); in the safe context (white background), no pain occurred. Generalization of avoidance was tested in 2 novel contexts (light/dark gray backgrounds). We assessed pain expectancy, pain-related fear, startle eyeblink responses for all trajectories, and avoidance behavior (ie, maximal deviation from shortest trajectory). Results indicated that differential fear and expectancy selectively generalized to the novel context resembling the original threat context in both groups. Interestingly and in contrast with the verbal reports, high-anxious participants avoided more in the novel context resembling the original safe context, but not in the 1 resembling the threat context. No generalization emerged in the startle data. Because excessive pain-related avoidance specifically may cause withdrawal from daily life activities, these findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability. PERSPECTIVE: This paper shows that high-anxious people do not overgeneralize pain-related fear and pain expectancy learned in a threat context more to novel, safe contexts than low-anxious individuals, but that they do avoid more in those contexts. These findings suggest that high-anxious individuals may be vulnerable to developing chronic pain disability.
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Affiliation(s)
- Ann Meulders
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Juliane Traxler
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium; Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristof Vandael
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Silke Scheepers
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium
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Pinto EA, Van Damme S, Torta DM, Meulders A. Modulation of attention to pain by goal-directed action: a somatosensory evoked potentials approach. PeerJ 2023; 11:e16544. [PMID: 38144185 PMCID: PMC10748472 DOI: 10.7717/peerj.16544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Background Attentional processes are modulated by current goal pursuit. While pursuing salient cognitive goals, individuals prioritize goal-related information and suppress goal-irrelevant ones. This occurs in the context of pain too, where nonpain cognitive goal pursuit was found to have inhibitory effects on pain-related attention. Crucially, how pursuing nonpain motor goals affects pain-related somatosensory attention is still unknown. The aim of this study was to investigate whether nonpain motor goal pursuit would attenuate pain-related somatosensory attention. Methods Healthy volunteers (N = 45) performed a robotic arm conditioning task where movements were paired with conflicting (pain and reward), threatening (only pain) or neutral (no pain and no reward) outcomes. To increase the motivational value of pursuing the nonpain motor goal, in the conflicting condition participants could receive a reward for a good motor performance. To examine somatosensory attention during movement, somatosensory evoked potentials (SEPs; N120 and P200) were obtained in response to innocuous tactile stimuli administered on a pain-relevant or pain-irrelevant body location. We expected that the threat of pain would enhance somatosensory attention. Furthermore, we expected that the possibility of getting a reward would inhibit this effect, due to pain-reward interactions. Results Against our predictions, the amplitude of the N120 did not differ across movement types and locations. Furthermore, the P200 component showed significantly larger SEPs for conflicting and threat movements compared to neutral, suggesting that the threat of pain increased somatosensory attention. However, this effect was not modulated by nonpain motor goal pursuit, as reflected by the lack of modulation of the N120 and P200 in the conflicting condition as compared to the threat condition. This study corroborates the idea that pain-related somatosensory attention is enhanced by threat of pain, even when participants were motivated to move to obtain a reward.
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Affiliation(s)
- Eleana A. Pinto
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Diana M. Torta
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Ann Meulders
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Hilger K, Häge AS, Zedler C, Jost M, Pauli P. Virtual reality to understand pain-associated approach behaviour: a proof-of-concept study. Sci Rep 2023; 13:13799. [PMID: 37612345 PMCID: PMC10447531 DOI: 10.1038/s41598-023-40789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
Pain-associated approach and avoidance behaviours are critically involved in the development and maintenance of chronic pain. Empirical research suggests a key role of operant learning mechanisms, and first experimental paradigms were developed for their investigation within a controlled laboratory setting. We introduce a new Virtual Reality paradigm to the study of pain-related behaviour and investigate pain experiences on multiple dimensions. The paradigm evaluates the effects of three-tiered heat-pain stimuli applied contingent versus non-contingent with three types of arm movements in naturalistic virtual sceneries. Behaviour, self-reported pain-related fear, pain expectancy and electrodermal activity were assessed in 42 healthy participants during an acquisition phase (contingent movement-pain association) and a modification phase (no contingent movement-pain association). Pain-associated approach behaviour, as measured by arm movements followed by a severe heat stimulus, quickly decreased in-line with the arm movement-pain contingency. Slower effects were observed in fear of movement-related pain and pain expectancy ratings. During the subsequent modification phase, the removal of the pain contingencies modified all three indices. In both phases, skin conductance responses resemble the pattern observed for approach behaviour, while skin conductance levels equal the pattern observed for the self-ratings. Our findings highlight a fast reduction in approach behaviour in the face of acute pain and inform about accompanying psychological and physiological processes. We discuss strength and limitations of our paradigm for future investigations with the ultimate goal of gaining a comprehensive understanding of the mechanisms involved in chronic pain development, maintenance, and its therapy.
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Affiliation(s)
- Kirsten Hilger
- Department of Psychology I, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany.
| | - Anne-Sophie Häge
- Department of Psychology I, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany
| | - Christina Zedler
- Department of Psychology I, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany
| | - Michael Jost
- Department of Psychology I, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology I, University of Würzburg, Marcusstr. 9-11, 97070, Würzburg, Germany
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7
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Dymond S, Xia W, Lloyd K, Schlund MW, Zuj DV. Working hard to avoid: Fixed-ratio response effort and maladaptive avoidance in humans. Q J Exp Psychol (Hove) 2023; 76:1889-1912. [PMID: 36112817 DOI: 10.1177/17470218221127660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Maladaptive avoidance of safe stimuli is a defining feature of anxiety and related disorders. Avoidance may involve physical effort or the completion of a fixed series of responses to prevent occurrence of, or cues associated with, the aversive event. Understanding the role of response effort in the acquisition and extinction of avoidance may facilitate the development of new clinical treatments for maladaptive avoidance. Despite this, little is known about the impact of response effort on extinction-resistant avoidance in humans. Here, we describe findings from two laboratory-based treatment studies designed to investigate the impact of high and low response effort on the extinction (Experiment 1) and return (Experiment 2) of avoidance. Response effort was operationalised as completion of fixed-ratio (FR) reinforcement schedules for both danger and safety cues in a multi-cue avoidance paradigm with behavioural, self-report, and physiology measures. Completion of the FR response requirements cancelled upcoming shock presentations following danger cues and had no impact on the consequences that followed safety cues. Both experiments found persistence of high response-effort avoidance across danger and safety cues and sustained (Experiment 1) and reinstated (Experiment 2) levels of fear and threat expectancy. Skin conductance responses evoked by all cues were similar across experiments. The present findings and paradigm have implications for translational research on maladaptive anxious coping and treatment development.
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Affiliation(s)
- Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Weike Xia
- School of Psychology, Swansea University, Swansea, UK
| | - Keith Lloyd
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Michael W Schlund
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Daniel V Zuj
- School of Psychology, Swansea University, Swansea, UK
- School of Psychological Sciences, University of Tasmania, Launceston, TAS, Australia
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Spix M, Melles H, Jansen A. From Bad to Worse: Safety Behaviors Exacerbate Eating Disorder Fears. Behav Sci (Basel) 2023; 13:574. [PMID: 37504021 PMCID: PMC10376478 DOI: 10.3390/bs13070574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with an eating disorder. The present study tested to what extent eating disorder safety behaviors increase threat perception in individuals with and without an eating disorder. For this, 108 individuals with a self-reported eating disorder diagnosis and 82 healthy controls rated the dangerousness of several short situations. The situations systematically varied in the presence of eating disorder safety behaviors and danger information. As expected, all participants perceived situations in which the protagonist executed an eating disorder safety behavior as more threatening than situations without a safety behavior. This 'behavior-as-information' effect was equally strong in individuals with and without an eating disorder. Additionally, safety behaviors strengthened threat perception more in safe situations than in dangerous situations. To conclude, the presence of eating disorder safety behavior can increase threat perception regardless of whether individuals have an eating disorder or not. This makes eating disorder safety behaviors a potential risk factor for the development and maintenance of eating disorder fears.
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Affiliation(s)
- Michelle Spix
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Hanna Melles
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
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Glogan E, Gatzounis R, Bennett MP, Holthausen K, Meulders A. Generalization of pain-related avoidance behavior based on de novo categorical knowledge. Pain 2023; 164:895-904. [PMID: 36149790 PMCID: PMC10026827 DOI: 10.1097/j.pain.0000000000002786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/02/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT People with chronic pain often fear and avoid movements and activities that were never paired with pain. Safe movements may be avoided if they share some semantic relationship with an actual pain-associated movement. This study investigated whether pain-associated operant responses (movements) can become categorically associated with perceptually dissimilar responses, thus motivating avoidance of new classes of safe movements-a phenomenon known as category-based avoidance generalization. Using a robotic arm, 2 groups were trained to categorize arm movements in different ways. Subsequently, the groups learned through operant conditioning that an arm movement from one of the categories was paired with a high probability of pain, whereas the others were paired with either a medium probability of pain or no pain (acquisition phase). Self-reported pain-related fear and pain expectancy were collected as indices of fear learning. During a final generalization test phase, the movements categorically related to those from the acquisition phase were made available but in the absence of pain. Results showed that the generalization of outcome measures depended on the categorical connections between arm movements, ie, the groups avoided and feared the novel generalization movement categorically related to the pain-associated acquisition movement, depending on how they had previously learned to categorize the movements. This suggests that operant pain-related avoidance can generalize to safe behaviors, which are not perceptually, but categorically, similar to a pain-associated behavior. This form of pain-related avoidance generalization is problematic because category-based relations can be extremely wide reaching and idiosyncratic. Thus, category-based generalization of operant pain-related avoidance merits further investigation.
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Affiliation(s)
- Eveliina Glogan
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Rena Gatzounis
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Marc Patrick Bennett
- Medical Research Council—Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Katharina Holthausen
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Ann Meulders
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
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Karayannis NV, Smuck M, Law C, Mackey SC, Gross JJ, Darnall BD, Hush J. Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain. Musculoskelet Sci Pract 2023; 63:102721. [PMID: 36759316 PMCID: PMC10566747 DOI: 10.1016/j.msksp.2023.102721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/15/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Inclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move. OBJECTIVE To characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures. DESIGN Cross-sectional study of 328 adults with chronic low back pain (CLBP). METHOD Spearman correlations assessed the relationship between pairs of measures. Multiple linear regression models assessed the association between self-reported measures of physical function and the grouping of physical capacity measures. Self-reported measures included Roland Morris Disability Questionnaire (RMDQ), PROMIS Physical Function, Pain Behavior, and Pain Interference; Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and Chronic Pain Acceptance Questionnaire (CPAQ). Capacity measures included walking speed and endurance, lower extremity functional strength, lumbopelvic range of motion, and trunk endurance. RESULTS PROMIS Physical Function was directly and weakly correlated with walking speed (ρ = 0.26, 2-min walk) and inversely and weakly correlated with lower extremity strength (ρ = -0.29, 5x sit-to-stand). RMDQ was not correlated with any of the capacity-based measures. PROMIS Physical Function was inversely and moderately correlated with Pain Interference (ρ = -0.48) and Pain Behavior (ρ = -0.43), PCS (ρ = -0.36), and FABQ (ρ = -0.31). The RMDQ was strongly correlated with PROMIS Physical Function (ρ = -0.56), Pain Behavior (ρ = 0.51) and Pain Interference (ρ = 0.49); and moderately correlated with PCS (ρ = 0.37) and FABQ (ρ = 0.33). PROMIS Physical Function and RMDQ were not correlated with CPAQ. Lower scores on PROMIS Physical Function were weakly associated with lower measures of lower extremity strength (-0.30, 95% CI: -0.51 to -0.09, p = 0.005). Higher scores on RMDQ were also weakly associated with lower measures of lower extremity strength (0.26, 95% CI: 0.11 to 0.41, p = 0.001). CONCLUSIONS A strong association emerged between self-reported limitations in physical function, pain behavior, and pain interference. A weak association emerged between self-reported physical function and lower extremity strength.
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Affiliation(s)
| | | | | | | | | | | | - Julia Hush
- MacQuarie University, Sydney, Australia.
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11
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Garcia-Guerrero S, O’Hora D, Zgonnikov A, Scherbaum S. The action dynamics of approach-avoidance conflict during decision-making. Q J Exp Psychol (Hove) 2023; 76:160-179. [PMID: 35236183 PMCID: PMC9773158 DOI: 10.1177/17470218221087625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Approach-avoidance conflict is observed in the competing motivations towards the benefits and away from the costs of a decision. The current study investigates the action dynamics of response motion during such conflicts in an attempt to characterise their dynamic resolution. An approach-avoidance conflict was generated by varying the appetitive consequences of a decision (i.e., point rewards and shorter participation time) in the presence of simultaneous aversive consequences (i.e., shock probability). Across two experiments, approach-avoidance conflict differentially affected response trajectories. Approach trajectories were less complex than avoidance trajectories and, as approach and avoidance motivations neared equipotentiality, response trajectories were more deflected from the shortest route to the eventual choice. Consistency in the location of approach and avoidance response options reduced variability in performance enabling more sensitive estimates of dynamic conflict. The time course of competing influences on response trajectories including trial-to-trial effects and conflict between approach and avoidance were estimated using regression analyses. We discuss these findings in terms of a dynamic theory of approach-avoidance that we hope will lead to insights of practical relevance in the field of maladaptive avoidance.
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Affiliation(s)
- Santiago Garcia-Guerrero
- School of Psychology, National University of Ireland, Galway, Ireland,Santiago Garcia-Guerrero, School of Psychology, National University of Ireland, University Road, Galway H91 TK33, Ireland.
| | - Denis O’Hora
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Arkady Zgonnikov
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Stefan Scherbaum
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
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12
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Vandael K, Meulders M, Mühlen KZ, Peters M, Meulders A. Increased positive affect is associated with less generalization of pain-related avoidance. Behav Res Ther 2022; 158:104199. [PMID: 36174262 DOI: 10.1016/j.brat.2022.104199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Abstract
Fear-avoidance models of chronic pain consider excessive spreading (or overgeneralization) of pain-related avoidance toward safe activities to play a crucial role in chronic pain disability. This study (N = 96) investigated whether avoidance generalization is mitigated by positive affect induction. Pain-free, healthy participants performed an arm-reaching task during which certain movements were followed by pain, while another was not. One group then performed an exercise to induce positive affect (positive affect group), while another group performed a neutral exercise (neutral group). A third group also performed the neutral exercise, but did not learn to avoid pain during the arm-reaching task (yoked neutral group). To test generalization, we introduced novel but similar movements that were never followed by pain in all groups. Results showed no differences in generalization between the positive affect and neutral groups; however, across groups, higher increases in positive affect were associated with less generalization of avoidance, and less generalization of pain-expectancy and pain-related fear. Compared to the yoked neutral group, the neutral group showed avoidance generalization, as well as pain-expectancy and pain-related fear generalization. These results point toward the potential of positive affect interventions in attenuating maladaptive spreading of pain-related avoidance behavior to safe activities.
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Affiliation(s)
- Kristof Vandael
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands; Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Michel Meulders
- Centre for Operations Research and Statistics, KU Leuven, Brussels, Belgium; Research Group on Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Katharina Zur Mühlen
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Madelon Peters
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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13
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Vandael K, Vasilache A, Meulders A. Know Your Movements: Poorer Proprioceptive Accuracy is Associated With Overprotective Avoidance Behavior. THE JOURNAL OF PAIN 2022; 23:1400-1409. [PMID: 35341984 DOI: 10.1016/j.jpain.2022.03.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/23/2022] [Accepted: 03/05/2022] [Indexed: 06/14/2023]
Abstract
Pain-related avoidance of movements that are actually safe (ie, overprotective behavior) plays a key role in chronic pain disability. Avoidance is reinforced through operant learning: after learning that a certain movement elicits pain, movements that prevent pain are more likely to be performed. Proprioceptive accuracy importantly contributes to motor learning and memory. Interestingly, reduced accuracy has been documented in various chronic pain conditions, prompting the question whether this relates to avoidance becoming excessive. Using robotic arm-reaching movements, we tested the hypothesis that poor proprioceptive accuracy is associated with excessive pain-related avoidance in pain-free participants. Participants first performed a task to assess proprioceptive accuracy, followed by an operant avoidance training during which a pain stimulus was presented when they performed one movement trajectory, but not when they performed another trajectory. During a test phase, movements were no longer restricted to 2 trajectories, but participants were instructed to avoid pain. Unbeknownst to the participants, the pain stimulus was never presented during this phase. Results supported our hypothesis. Furthermore, exploratory analyses indicated a reduction in proprioceptive accuracy after avoidance learning, which was associated with excessive avoidance and higher trait fear of pain. PERSPECTIVE: This study is the first to show that poorer proprioceptive accuracy is associated with excessive pain-related avoidance. This finding is especially relevant for chronic pain conditions, as reduced accuracy has been documented in these populations, and points toward the need for research on training accuracy to tackle excessive avoidance.
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Affiliation(s)
- Kristof Vandael
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Alexandra Vasilache
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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14
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Glogan E, Meulders M, Pfeiffer L, Vlaeyen JWS, Meulders A. Alike, But Not Quite: Comparing the Generalization of Pain-Related Fear and Pain-Related Avoidance. THE JOURNAL OF PAIN 2022; 23:1616-1628. [PMID: 35508274 DOI: 10.1016/j.jpain.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
Pain-related fear and -avoidance crucially contribute to pain chronification. People with chronic pain may adopt costly avoidance strategies above and beyond what is necessary, aligning with experimental findings of excessive fear generalization to safe movements in these populations. Furthermore, recent evidence suggests that, when avoidance is costly, it can dissociate from fear. Here, we investigated whether concurrently measured pain-related fear and costly avoidance generalization correspond in one task. We also explored whether healthy participants avoid excessively despite associated costs, and if avoidance would decrease as a function of dissimilarity from a pain-associated movement. In a robotic arm-reaching task, participants could avoid a low-cost, pain-associated movement trajectory (T+), by choosing a high-cost non-painful movement trajectory (T-), at opposite ends of a movement plane. Subsequently, in the absence of pain, we introduced three movement trajectories (G1-3) between T+ and T-, and one movement trajectory on the side of T- opposite to T+ (G4), linearly increasing in costs from T+ to G4. Avoidance was operationalized as maximal deviation from T+, and as trajectory choice. Fear learning was measured using self-reported pain-expectancy, pain-related fear, and startle eye-blink electromyography. Self-reports generalized, both decreasing with increasing distance from T+. In contrast, all generalization trajectories were chosen equally, suggesting that avoidance-costs and previous pain balanced each other out. No effects emerged in the electromyography. These results add to a growing body of literature showing that (pain-related) avoidance, especially when costly, can dissociate from fear, calling for a better understanding of the factors motivating, and mitigating, disabling avoidance. PERSPECTIVE: This article presents a comparison of pain-related fear- and avoidance generalization, and an exploration of excessive avoidance in healthy participants. Our findings show that pain-related avoidance can dissociate from fear, especially when avoidance is costly, calling for a better understanding of the factors motivating and mitigating disabling avoidance.
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Affiliation(s)
- Eveliina Glogan
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Michel Meulders
- Research Centre for Mathematics, Education, Econometrics and Statistics, KU Leuven, Leuven, Belgium; Research Group Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Leon Pfeiffer
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Ann Meulders
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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15
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Gatzounis R, Meulders A. Pain and avoidance: The potential benefits of imagining your best possible self. Behav Res Ther 2022; 153:104080. [DOI: 10.1016/j.brat.2022.104080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/02/2022]
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16
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Krypotos AM, Crombez G, Alves M, Claes N, Vlaeyen JWS. The exploration-exploitation dilemma in pain: an experimental investigation. Pain 2022; 163:e215-e233. [PMID: 34108434 DOI: 10.1097/j.pain.0000000000002352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Daily life consists of a chain of decisions. Typically, individuals may choose to pursue what they already know (exploitation) or to search for other options (exploration). This exploration-exploitation dilemma is a topic of interest across multiple scientific fields. Here we propose that investigating how individuals solve this dilemma may improve our understanding of how individuals make behavioral decisions (eg, avoidance) when facing pain. To this end, we present the data of 3 experiments in which healthy individuals were given the opportunity to choose between 4 different movements, with each movement being associated with different probabilities of receiving a painful outcome only (experiment 1) or pain and/or a reward (experiment 2). We also investigated whether participants stuck to their decisions when the contingencies between each movement and the painful/rewarding outcome changed during the task (experiment 3). The key findings across all experiments are the following: First, after initial exploration, participants most often exploited the safest option. Second, participants weighted rewards more heavily than receiving pain. Finally, after receiving a painful outcome, participants were more inclined to explore than to exploit a rewarding movement. We argue that by focusing more on how individuals in pain solve the exploration-exploitation dilemma is helpful in understanding behavioral decision making in pain.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Department of Clinical Psychology, Utrecht University
| | - Geert Crombez
- Department of Experimental-Clinical and Heath Psychology, Ghent University, Ghent, Belgium
| | - Maryna Alves
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
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17
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Labrenz F, Woud ML, Elsenbruch S, Icenhour A. The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine. Front Psychiatry 2022; 13:841734. [PMID: 35250678 PMCID: PMC8894646 DOI: 10.3389/fpsyt.2022.841734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022] Open
Abstract
Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.
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Affiliation(s)
- Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.,Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
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18
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Wong AHK, Pittig A. Avoiding a feared stimulus: Modelling costly avoidance of learnt fear in a sensory preconditioning paradigm. Biol Psychol 2021; 168:108249. [PMID: 34973369 DOI: 10.1016/j.biopsycho.2021.108249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/27/2022]
Abstract
Avoidance of learnt fear prevents the onset of a feared stimulus and the threat that follows. In anxiety-related disorders, it turns pathological given its cost and persistence in the absence of realistic threat. The current study examined the acquisition of costly avoidance of learnt fear in healthy individuals (n = 45), via a sensory preconditioning paradigm. Two neutral preconditioning stimuli (PSs) were paired with two neutral conditioned stimuli (CSs). One CS then came to predict an aversive outcome whereas the other CS came to predict safety. In test, participants engaged in stronger avoidance to the PS associated with the fear-related CS than the PS associated with the safety-related CS. Of note, executing behavioral avoidance led to missing out a competing reward, thus rendering avoidance costly. The results also provide preliminary evidence that threat anticipation and a negative change in valence play a role in driving costly avoidance of learnt fear. Future studies should examine how avoidance of learnt fear maintains pathological anxiety.
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Affiliation(s)
- Alex H K Wong
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Andre Pittig
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany; Translational Psychotherapy, Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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19
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Kloos T, van Vliet C, Riecke J, Meulders A. Indoor or outdoor? Generalization of costly pain-related avoidance behavior to conceptually related contexts. THE JOURNAL OF PAIN 2021; 23:657-668. [PMID: 34793960 DOI: 10.1016/j.jpain.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022]
Abstract
When pain persists beyond healing time and becomes a "false alarm" of bodily threat, protective strategies, such as avoidance, are no longer adaptive. More specifically, generalization of avoidance based on conceptual knowledge may contribute to chronic pain disability. Using an operant robotic-arm avoidance paradigm, healthy participants (N=50), could perform more effortful movements in the threat context (e.g. pictures of outdoor scenes) to avoid painful stimuli, whereas no pain occured in the safe context (e.g. pictures of indoor scenes). Next, we investigated avoidance generalization to conceptually related contexts (i.e. novel outdoor/indoor scenes). As expected, participants avoided more when presented with novel contexts conceptually related to the threat context than in novel exemplars of the safe context. Yet, exemplars belonging to one category (outdoor/indoor scenes) were not interchangeable; there was a generalization decrement. Posthoc analyses revealed that contingency-aware participants (n=27), but not non-aware participants (n=23), showed the avoidance generalization effect and also generalized their differential pain-expectancy and pain-related fear more to novel background scenes conceptually related to the original threat context. In contrast, the fear-potentiated startle response was not modulated by context.
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Affiliation(s)
- Tabea Kloos
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Christine van Vliet
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Jenny Riecke
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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20
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Glogan E, Vandael K, Gatzounis R, Meulders A. When Do We Not Face Our Fears? Investigating the Boundary Conditions of Costly Pain-Related Avoidance Generalization. THE JOURNAL OF PAIN 2021; 22:1221-1232. [PMID: 33852945 DOI: 10.1016/j.jpain.2021.03.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
Excessive generalization of fear and avoidance are hallmark symptoms of chronic pain disability, yet research focusing on the mechanisms underlying generalization of avoidance specifically, is scarce. Two experiments investigated the boundary conditions of costly pain-related avoidance generalization in healthy participants who learned to avoid pain by performing increasingly effortful (in terms of deviation and force) arm-movements using a robot-arm (acquisition). During generalization, novel, but similar arm-movements, without pain, were tested. Experiment 1 (N = 64) aimed to facilitate generalization to these movements by reducing visual contextual changes between acquisition and generalization, whereas Experiment 2 (N = 70) aimed to prevent extinction by increasing pain uncertainty. Both experiments showed generalization of pain-expectancies and pain-related fear. However, Experiment 2 was the first and only to also demonstrate generalization of avoidance, ie, choosing the novel effortful arm-movements in the absence of pain. These results suggest that uncertainty about the occurrence of pain may delay recovery, due to reduced disconfirmation of threat beliefs when exploring, resulting in persistent avoidance. PERSPECTIVE: This article demonstrates generalization of instrumentally acquired costly pain-related avoidance in healthy people under conditions of uncertainty. The results suggest that targeting pain-related uncertainty may be a useful tool for clinicians adopting a psychological approach to treating excessive pain-related avoidance in chronic pain.
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Affiliation(s)
- Eveliina Glogan
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Kristof Vandael
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Laboratory of Biological Psychology, KU Leuven, Leuven, Belgium
| | - Rena Gatzounis
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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21
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Morriss J, Zuj DV, Mertens G. The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. Int J Psychophysiol 2021; 166:116-126. [PMID: 34097936 DOI: 10.1016/j.ijpsycho.2021.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Daniel V Zuj
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Swansea, UK
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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22
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Pain by mistake: investigating a link between error-related negativity and pain avoidance behavior. Pain 2021; 163:e190-e201. [PMID: 34074947 DOI: 10.1097/j.pain.0000000000002358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pain can be considered as a signal of "bodily error": Errors put organisms at danger and activate behavioral defensive systems. If the error is of physical nature, pain is the warning signal that motivates protective action such as avoidance behavior to safeguard our body's integrity. Interestingly, an important component of neural error processing, the error-related negativity (ERN), has been found to be related to avoidance in anxiety disorders. The present study is the first to extend these findings to pain and investigate the relationship between ERN and pain-related avoidance behavior. It was hypothesized that individuals with larger ERN amplitudes would show more pain-related avoidance behavior and would be more persistent in their avoidance despite changes in the environment. Fifty-three healthy individuals performed the Eriksen Flanker task during which their brain activity upon correct and erroneous motor responses was recorded by means of high-density electroencephalography. Avoidance behavior was assessed with an arm-reaching task using the HapticMaster robot arm. Results showed that, in contrast to our hypothesis, avoidance was not related to ERN amplitudes. Surprisingly, persons with elevated ERN amplitudes showed low levels of avoidance specifically during early acquisition trials. In contrast to earlier findings in anxiety disorders, individuals with elevated ERN amplitudes did not engage in more pain-related avoidance behavior. In fact, the opposite pattern was found at the start of acquisition: individuals with higher compared to lower ERN amplitudes were slower in learning to avoid pain. Replications and future studies on the relationship between ERN and avoidance behavior are needed.
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23
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Individual Differences in the Focus: Understanding Variations in Pain-Related Fear and Avoidance Behavior from the Perspective of Personality Science. Pain 2021; 163:e151-e152. [PMID: 34074946 DOI: 10.1097/j.pain.0000000000002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
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24
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Kinematic changes in goal-directed movements in a fear-conditioning paradigm. Sci Rep 2021; 11:11162. [PMID: 34045515 PMCID: PMC8159940 DOI: 10.1038/s41598-021-90518-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/10/2021] [Indexed: 11/08/2022] Open
Abstract
In individuals with a musculoskeletal disorder, goal-directed reaching movements of the hand are distorted. Here, we investigated a pain-related fear-conditioning effect on motor control. Twenty healthy participants (11 women and 9 men, 21.7 ± 2.7 years) performed a hand-reaching movement task. In the acquisition phase, a painful electrocutaneous stimulus was applied on the reaching hand simultaneous with the completion of reaching. In the subsequent extinction phase, the task context was the same but the painful stimulus was omitted. We divided the kinematic data of the hand-reaching movements into acceleration and deceleration periods based on the movement-velocity characteristics, and the duration of each period indicated the degree of impairment in the feedforward and feedback motor controls. We assessed the wavelet coherence between electromyograms of the triceps and biceps brachii muscles. In the acquisition phase, the durations of painful movements were significantly longer in both the acceleration and deceleration periods. In the extinction phase, painful movements were longer only in the acceleration period and higher pain expectation and fear were maintained. Similarly, the wavelet coherence of muscles in both periods were decreased in both the acquisition and extinction phases. These results indicate that negative emotional modulations might explain the altered motor functions observed in pain patients.
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25
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Osumi M, Sumitani M, Nishi Y, Nobusako S, Dilek B, Morioka S. Fear of movement-related pain disturbs cortical preparatory activity after becoming aware of motor intention. Behav Brain Res 2021; 411:113379. [PMID: 34051229 DOI: 10.1016/j.bbr.2021.113379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
Fear of movement-related pain is known to disturb the process of motor preparation in patients with chronic pain. In the present study, we aimed to clarify the neural mechanisms underlying the influence of fear movement-related pain on motor preparatory brain activity using Libet's clock and electroencephalography (EEG). Healthy participants were asked to press a button while watching a rotating Libet's clock-hand, and report the number on the clock ("W time") when they made the "decision" to press the button with their right index finger. Immediately after pressing the button, a painful electrical stimulus was delivered to the dorsum of the left hand, causing participants to feel fear of movement (button press-related pain). We found that fear of movement-related pain caused the W time to be early, and that the amplitudes of readiness potentials (RPs) increased after awareness of motor intention emerged. In addition, fear of movement-related pain caused over-activation of the medial frontal cortex, supplementary motor area, cingulate motor area, and primary motor cortex after participants became aware of their motor intention. Such over-activation might result from conflict between the unrealized desire to escape from a painful experience and motivation to perform a required motor task.
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Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Nishi
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Satoshi Nobusako
- Graduate School of Health Science, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Burcu Dilek
- Trakya University, Faculty of Health Sciences, Department of Occupational Therapy, Edirne, Turkey; Institute of Health Sciences, PhD Candidate in Neuroscience, Istanbul Medipol University, Istanbul, Turkey
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan
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26
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Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory. THE JOURNAL OF PAIN 2021; 22:1315-1327. [PMID: 34029684 DOI: 10.1016/j.jpain.2021.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
Abstract
Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. Perspectives: Inspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.
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Avoidance behaviour performed in the context of a novel, ambiguous movement increases threat and pain-related fear. Pain 2021; 162:875-885. [PMID: 32947543 DOI: 10.1097/j.pain.0000000000002079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT The fear-avoidance model of chronic pain predicts that catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability. Here, we investigated whether performing a movement to avoid a painful stimulus in the context of a novel movement increases threat and pain-related fear towards this novel movement and whether avoidance behaviour persisted when given the choice between performing the acquired movement to avoid a painful stimulus or an alternative, novel movement. Applying a robotic arm-reaching task, participants could choose between 2 movements to reach a target location: a short, but painful movement trajectory, or a longer nonpainful movement trajectory. After avoidance acquisition, the option to choose the painful trajectory was removed. The experimental group (N = 50) could choose between the longest trajectory or a novel intermediate trajectory, whereas the control group (N = 50) was allowed to only perform the novel trajectory. In a final test, participants of both groups were allowed to choose any of the 3 trajectories. After acquisition, experimental group participants showed elevated pain expectancy and pain-related fear towards the novel trajectory, compared with the control group. During test, the experimental group participants persisted in performing the longest pain-free (avoidance) trajectory and were less likely to choose the novel trajectory. In addition, these participants maintained higher levels of pain-related fear for the novel trajectory compared with the control group. These findings suggest that avoidance in the context of other neutral activities/movements may lead to the development and maintenance of threat appraisals and irrational fears.
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Pittig A, Boschet JM, Glück VM, Schneider K. Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach. Depress Anxiety 2021; 38:361-371. [PMID: 33258530 DOI: 10.1002/da.23119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 11/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathological avoidance is a transdiagnostic characteristic of anxiety disorders. Avoidance conditioning re-emerged as a translational model to examine mechanisms and treatment of avoidance. However, its validity for anxiety disorders remains unclear. METHODS This study tested for altered avoidance in patients with anxiety disorders compared to matched controls (n = 40/group) using instrumental conditioning assessing low-cost avoidance (avoiding a single aversive outcome) and costly avoidance (avoidance conflicted with gaining rewards). Autonomic arousal and threat expectancy were assessed as indicators of conditioned fear. Associations with dimensional symptom severity were examined. RESULTS Patients and controls showed frequent low-cost avoidance without group differences. Controls subsequently inhibited avoidance to gain rewards, which was amplified when aversive outcomes discontinued. In contrast, patients failed to reduce avoidance when aversive and positive outcomes competed (elevated costly avoidance) and showed limited reduction when aversive outcomes discontinued (persistent costly avoidance). Interestingly, elevated costly avoidance was not linked to higher conditioned fear in patients. Moreover, individual data revealed a bimodal distribution of costly avoidance: Some patients showed persistent avoidance, others showed little to no avoidance. Persistent versus low avoiders did not differ in other task-related variables, response to gains and losses in absence of threat, sociodemographic data, or clinical characteristics. CONCLUSIONS Findings suggest that anxious psychopathology is associated with a deficit to inhibit avoidance in presence of competing positive outcomes. This offers novel perspectives for research on mechanisms and treatment of anxiety disorders.
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Affiliation(s)
- Andre Pittig
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.,Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Juliane M Boschet
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Valentina M Glück
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Kristina Schneider
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.,Center of Mental Health, University of Würzburg, Würzburg, Germany
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Gatzounis R, van Vliet C, Meulders A. Will that hurt? A contingency learning task to assess pain-expectancy judgments for low back postures. J Behav Ther Exp Psychiatry 2021; 70:101622. [PMID: 33129131 DOI: 10.1016/j.jbtep.2020.101622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Contingency learning, i.e. learning that a cue predicts the presence (or absence) of an event, is central to the formation of beliefs regarding painfulness of body postures. Such beliefs may spread to safe cues due to compromised learning (e.g., excessive generalization, impaired safety learning), prompting avoidance and leading to disability. Despite its importance, compromised learning about low back pain is underinvestigated. We propose a low back pain scenario contingency learning task for the investigation of back pain-related learning. METHODS Sixty healthy participants viewed pictures of an avatar in various back postures, and for each posture gave pain-expectancy judgments and viewed the verbal outcome (pain/no pain) for a fictive back pain patient. During acquisition, one posture was followed by pain (conditioned stimulus; CS+), whereas another was not (CS-). During generalization, unreinforced novel intermediate back postures (generalization stimuli; GSs) were tested. During extinction, only the CSs were presented, not followed by pain. During generalization of extinction, only the GSs were presented, not followed by pain. RESULTS Participants expected pain more for the CS + than the CS- (differential acquisition) and generalized their pain-expectancy to the GS most similar to the CS+ (generalization). During extinction, pain-expectancy for the CS + decreased and generalized to the GS most similar to the CS+ (generalization of extinction). LIMITATIONS Future research should investigate generalizability of findings to clinical samples and consider the role of pre-existing pain threat beliefs. CONCLUSIONS This task is an easily applicable, non-invasive way to investigate the formation of back pain-related threat beliefs.
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Affiliation(s)
- Rena Gatzounis
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands.
| | - Christine van Vliet
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Ann Meulders
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
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Biggs EE, Timmers I, Meulders A, Vlaeyen JW, Goebel R, Kaas AL. The neural correlates of pain-related fear: A meta-analysis comparing fear conditioning studies using painful and non-painful stimuli. Neurosci Biobehav Rev 2020; 119:52-65. [DOI: 10.1016/j.neubiorev.2020.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/18/2020] [Accepted: 09/07/2020] [Indexed: 01/24/2023]
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31
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Karos K, Meulders A, Leyssen T, Vlaeyen JW. Freeze-like responses to pain in humans and its modulation by social context. PeerJ 2020; 8:e10094. [PMID: 33240593 PMCID: PMC7680627 DOI: 10.7717/peerj.10094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Maladaptive defensive responses such as excessive avoidance behavior have received increasing attention as a main mechanism for the development and maintenance of chronic pain complaints. However, another defensive response which is commonly studied in animals as a proxy for fear is freezing behavior. No research to date has investigated human freezing behavior in the context of pain. In addition, there is an increasing realization that social context can affect pain-relevant processes such as pain experience and pain behavior but less is known about the effects of social context on defensive responses to pain. Hence, this study investigated freezing behavior and facial pain expression in the context of pain, and their modulation by social context. Methods Healthy, pain-free participants (N = 39) stood on a stabilometric force platform in a threatening or safe social context, which was manipulated using angry or happy facial stimuli. In some trials, an auditory cue (conditioned stimulus; CS) predicted the occurrence of painful electrocutaneous stimulus (unconditioned stimulus; pain-US). We assessed body sway (an index of freezing), heart rate, facial pain expression, self-reported pain intensity, unpleasantness, and pain-US expectancy during the CS and the context alone (no CS). Results The results were mixed. Neither the anticipation of pain, nor social context affected body sway. Heart rate and painful facial expression were reduced in the threatening social context at high anxiety levels. A threatening social context also elicited higher pain-US expectancy ratings. In sum, a threatening social context increases the expectation of pain, but reduces the facial expression of pain and lowers heart rate in highly anxious individuals.
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Affiliation(s)
- Kai Karos
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium.,Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands.,Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
| | - Tine Leyssen
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
| | - Johan W Vlaeyen
- Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands.,Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
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Avoiding Based on Shades of Gray: Generalization of Pain-Related Avoidance Behavior to Novel Contexts. THE JOURNAL OF PAIN 2020; 21:1212-1223. [DOI: 10.1016/j.jpain.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
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33
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Gatzounis R, Meulders A. Once an Avoider Always an Avoider? Return of Pain-Related Avoidance After Extinction With Response Prevention. THE JOURNAL OF PAIN 2020; 21:1224-1235. [DOI: 10.1016/j.jpain.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022]
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Krypotos AM, Crombez G, Meulders A, Claes N, Vlaeyen JWS. Decomposing conditioned avoidance performance with computational models. Behav Res Ther 2020; 133:103712. [PMID: 32836110 DOI: 10.1016/j.brat.2020.103712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/30/2022]
Abstract
Avoidance towards innocuous stimuli is a key characteristic across anxiety-related disorders and chronic pain. Insights into the relevant learning processes of avoidance are often gained via laboratory procedures, where individuals learn to avoid stimuli or movements that have been previously associated with an aversive stimulus. Typically, statistical analyses of data gathered with conditioned avoidance procedures include frequency data, for example, the number of times a participant has avoided an aversive stimulus. Here, we argue that further insights into the underlying processes of avoidance behavior could be unraveled using computational models of behavior. We then demonstrate how computational models could be used by reanalysing a previously published avoidance data set and interpreting the key findings. We conclude our article by listing some challenges in the direct application of computational modeling to avoidance data sets.
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Affiliation(s)
- Angelos-Miltiadis Krypotos
- Department of Health Psychology, KU Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Netherlands.
| | - Geert Crombez
- Department of Experimental-Clinical and Heath Psychology, Ghent University, Belgium
| | - Ann Meulders
- Department of Health Psychology, KU Leuven, Belgium; Experimental Health Psychology, Maastricht University, Netherlands
| | | | - Johan W S Vlaeyen
- Department of Health Psychology, KU Leuven, Belgium; Experimental Health Psychology, Maastricht University, Netherlands
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35
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Peeters G, Bennett M, Donoghue OA, Kennelly S, Kenny RA. Understanding the aetiology of fear of falling from the perspective of a fear-avoidance model – A narrative review. Clin Psychol Rev 2020; 79:101862. [DOI: 10.1016/j.cpr.2020.101862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
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Pain can be conditioned to voluntary movements through associative learning: an experimental study in healthy participants. Pain 2020; 161:2321-2329. [PMID: 32404653 DOI: 10.1097/j.pain.0000000000001919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Experimental data suggest that associative learning can influence defensive avoidance behavior and pain perception in humans. However, whether voluntary movements can become conditioned stimuli (CSs) and influence pain responses is yet to be evaluated. Forty healthy volunteers participated in this study. Electrocutaneous stimuli applied to the shoulder at pain threshold level (US) and at pain tolerance level (US) were determined before a movement-conditioning paradigm. First, reaching movements to visual cues shown on one side of a computer screen were associated with the US (CS+ movements) on 80% of trials, whereas reaching movements to visual stimuli shown on the other side were never associated with the nociceptive-US (CS- movements). Next, participants underwent a test phase in which movements to visual cues on both sides were paired with the US on 50% of trials. During the test phase, participants were asked to evaluate whether the movement was painful (yes/no) and to rate pain intensity after each trial. Movement onset and duration as well as skin conductance responses were collected. The US stimuli were more likely to be perceived as painful and were also rated as more painful during CS+ movements. Movement onset latency and skin conductance responses were significantly higher in anticipation of the CS+ movement as compared to the CS- movement. These findings suggest that pain can be conditioned to voluntary movements.
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37
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Costly avoidance triggered by categorical fear generalization. Behav Res Ther 2020; 129:103606. [PMID: 32224325 DOI: 10.1016/j.brat.2020.103606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/18/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
Fear generalization refers to the spread of acquired fear to novel stimuli that resemble the original fear-related stimulus. Preliminary evidence suggests that excessive fear generalization is a pathogenic feature of anxiety disorders, however, it remains unclear how fear generalization affects pathological avoidance. The current study thus aimed to examine the link between categorical fear generalization and costly avoidance. By combining a fear acquisition training phase and an avoidance test, the current findings showed that acquired fear spreads to novel stimuli that belonged to the same category of the original fear-related stimuli, but not to those that belonged to the fear-irrelevant categories. Importantly, participants avoided these fear-related novel stimuli despite costs. The current findings indicate that categorical fear generalization triggers costly avoidance. In terms of clinical implication, a decrease in costly avoidance aligned with a decrease in US expectancies. This emphasizes that behavioral approach may initiate extinction learning.
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Changes in Pain-Related Fear and Pain When Avoidance Behavior is no Longer Effective. THE JOURNAL OF PAIN 2020; 21:494-505. [DOI: 10.1016/j.jpain.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 12/28/2022]
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39
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Glogan E, Gatzounis R, Meulders M, Meulders A. Generalization of instrumentally acquired pain-related avoidance to novel but similar movements using a robotic arm-reaching paradigm. Behav Res Ther 2020; 124:103525. [DOI: 10.1016/j.brat.2019.103525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
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40
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Timmers I, Quaedflieg CWEM, Hsu C, Heathcote LC, Rovnaghi CR, Simons LE. The interaction between stress and chronic pain through the lens of threat learning. Neurosci Biobehav Rev 2019; 107:641-655. [PMID: 31622630 DOI: 10.1016/j.neubiorev.2019.10.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
Stress and pain are interleaved at multiple levels - interacting and influencing each other. Both are modulated by psychosocial factors including fears, beliefs, and goals, and are served by overlapping neural substrates. One major contributing factor in the development and maintenance of chronic pain is threat learning, with pain as an emotionally-salient threat - or stressor. Here, we argue that threat learning is a central mechanism and contributor, mediating the relationship between stress and chronic pain. We review the state of the art on (mal)adaptive learning in chronic pain, and on effects of stress and particularly cortisol on learning. We then provide a theoretical integration of how stress may affect chronic pain through its effect on threat learning. Prolonged stress, as may be experienced by patients with chronic pain, and its resulting changes in key brain networks modulating stress responses and threat learning, may further exacerbate these impairing effects on threat learning. We provide testable hypotheses and suggestions for how this integration may guide future research and clinical approaches in chronic pain.
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Affiliation(s)
- Inge Timmers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, United States.
| | - Conny W E M Quaedflieg
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Connie Hsu
- Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, United States
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, United States
| | - Cynthia R Rovnaghi
- Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Stanford, CA 94304, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 300, Palo Alto, CA 94304, United States
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Adamczyk WM, Buglewicz E, Szikszay TM, Luedtke K, Bąbel P. Reward for Pain: Hyperalgesia and Allodynia Induced by Operant Conditioning: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:861-875. [DOI: 10.1016/j.jpain.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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42
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Alaiti RK, Harvie DS, Gasparin JT, de Sousa MF, Pompeu JE, Madden VJ, Leite Hunziker MH, da Costa MF. Distorted distance perception to reachable points in people with chronic shoulder pain. Musculoskelet Sci Pract 2019; 42:120-124. [PMID: 31112924 DOI: 10.1016/j.msksp.2019.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 03/08/2019] [Accepted: 04/27/2019] [Indexed: 01/29/2023]
Abstract
Perception is not simply a carbon copy of the real world, but is subject to distortions that may reflect protective drive. This study aimed to investigate whether people with chronic shoulder pain show perceptual distortions of space and body that may promote protective behavior. Eighty-four people with shoulder pain and 51 healthy controls participated. Participants estimated (1) distances to points on a cork-board within and outside reaching distance, and (2) the perceived length of their own arms. A novel measure of movement-related pain was also used to determine whether movement-related pain relates to perceptual distortion. Overall, distance and arm length estimates did not differ between groups, nor did participants perceive their arms to be of different length. However, a moderate correlation between movement-related pain and the index of distance perception was found within the pain group, specifically for distance estimates to points within reach. Our results suggest that distorted perception is not a typical consequence of chronic shoulder pain; however, that it may occur in cases where pain is strongly linked to movement. Our findings have implications for understanding avoidance of movement in people with persistent pain.
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Affiliation(s)
- Rafael K Alaiti
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil.
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Australia; School of Allied Health Sciences, Griffin University, Australia
| | - Juliana T Gasparin
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil
| | - Marcello F de Sousa
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil
| | - José E Pompeu
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil; Department of Physiotherapy, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Marcelo F da Costa
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil; Department of Experimental Psychology, Universidade de São Paulo, São Paulo, Brazil
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Janssens T, Meulders A, Cuyvers B, Colloca L, Vlaeyen JW. Placebo and nocebo effects and operant pain-related avoidance learning. Pain Rep 2019; 4:e748. [PMID: 31583361 PMCID: PMC6749895 DOI: 10.1097/pr9.0000000000000748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Research on learning in placebo and nocebo has relied predominantly on Pavlovian conditioning procedures. Operant learning procedures may more accurately model learning in real-life situations in which placebo and nocebo effects occur. OBJECTIVES To investigate the development and persistence of placebo and nocebo effects using an operant avoidance learning task. METHODS Pain-free participants (n = 58) could learn to avoid pain by performing movements that differed in difficulty and intensity of painful stimulation. Participants performed movements in 2 contexts. In the high cost of avoidance context, pain stimulus intensity reduced with increasing movement difficulty. In the low cost of avoidance context, contingencies were reversed. Participants rated pain expectations and pain intensity. During test, movement difficulties were unchanged, but participants always received a medium-intensity pain stimulus. Placebo and nocebo effects were defined as lower/higher pain intensity ratings for trajectories that previously resulted in low/high-intensity compared with medium-intensity stimulation. RESULTS As expected, participants acquired differential movement-pain expectations and differential movement choices. Testing with a medium-intensity pain stimulus quickly erased differences in movement choice across contexts, but differences in pain expectations were maintained. Pain modulation across context was in line with movement-pain expectations. However, we only observed placebo effects within the low cost of avoidance context and found no evidence of nocebo effects. CONCLUSION Operant learning can change pain expectations, pain modulation, and pain-related avoidance behavior. Persisting pain expectations suggest that acquired pain beliefs may be resistant to disconfirmation, despite self-initiated experience with novel pain-movement contingencies.
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Affiliation(s)
- Thomas Janssens
- Health Psychology, KU Leuven (University of Leuven), Leuven, Belgium
| | - Ann Meulders
- Health Psychology, KU Leuven (University of Leuven), Leuven, Belgium
- Research Group Behavioral Medicine, Maastricht University, Maastricht, the Netherlands
| | - Bien Cuyvers
- Health Psychology, KU Leuven (University of Leuven), Leuven, Belgium
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, BaltimoreMD, USA
- Department of Anesthesiology/Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD, USA
| | - Johan W.S. Vlaeyen
- Health Psychology, KU Leuven (University of Leuven), Leuven, Belgium
- Research Group Behavioral Medicine, Maastricht University, Maastricht, the Netherlands
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44
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Meulders A. From fear of movement-related pain and avoidance to chronic pain disability: a state-of-the-art review. Curr Opin Behav Sci 2019. [DOI: 10.1016/j.cobeha.2018.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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45
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Gatzounis R, Schrooten MGS, Crombez G, Vlaeyen JWS. Effects of activity interruptions by pain on pattern of activity performance - an experimental investigation. Scand J Pain 2019; 18:109-119. [PMID: 29794288 DOI: 10.1515/sjpain-2017-0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Suspending an ongoing activity with the intention to resume it again later is a natural response to pain. This response facilitates coping with the pain, but it may also have negative consequences for the resumption and performance of the activity. For example, people with pain problems are often forced to take a break from doing their household chores because of their pain. They might delay resuming their chore, eventually needing longer time to finish it. We investigated how activity interruptions by pain influence the pattern of subsequent activity performance. We expected that when an activity is interrupted by pain (compared to non-pain), people spend longer time away from the activity, need longer time to complete it, and are less motivated to perform it. METHODS Sixty healthy volunteers performed an ongoing task that required them to make joystick movements in different directions according to a specific rule. Occasionally, participants received either a painful electrocutaneous stimulus or a non-painful and non-aversive auditory stimulus (between-subjects) as an interruption cue. The interruption cue was followed by the temporary suspension of the ongoing task and the initiation of a different activity (interruption task). The latter required the categorization of cards and had a maximum duration, but participants could also stop it earlier by pressing a button. We measured time away from the (interrupted) ongoing task, total time to complete the ongoing task (including the interruptions) and self-reported motivation to perform both the ongoing as well as the interruption task. RESULTS Groups did not differ in the time away from the ongoing task, total time to complete the ongoing task, or self-reported motivation to perform the two tasks. CONCLUSIONS Activity interruptions by pain did not impair the pattern of activity performance more than activity interruptions by non-pain. Potential explanations and suggestions for future research are discussed. IMPLICATIONS Interrupting ongoing activities is a common response to pain. However, activity interruptions by pain do not appear to influence the pattern of activity performance in a different way than activity interruptions by pain-irrelevant external stimuli.
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Affiliation(s)
- Rena Gatzounis
- Research Group Health Psychology, University of Leuven, Tiensestraat 102, Box 3726, B-3000 Leuven, Belgium.,Clinical Psychological Science, Maastricht University, P. O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Martien G S Schrooten
- Centre for Health and Medical Psychology, Örebro University, Örebro, Sweden.,Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium.,Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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Dymond S. Overcoming avoidance in anxiety disorders: The contributions of Pavlovian and operant avoidance extinction methods. Neurosci Biobehav Rev 2019; 98:61-70. [DOI: 10.1016/j.neubiorev.2019.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 01/29/2023]
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Adamczyk WM, Wiercioch-Kuzianik K, Bajcar EA, Bąbel P. Rewarded placebo analgesia: A new mechanism of placebo effects based on operant conditioning. Eur J Pain 2019; 23:923-935. [PMID: 30620151 DOI: 10.1002/ejp.1360] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Placebo analgesia is explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. We aimed to induce placebo analgesia by operant conditioning. METHODS Three groups of participants received electrocutaneous pain stimuli of the same intensity, preceded by either an orange or blue stimulus. In the conditioning phase of the study, participants from the experimental group were rewarded for low pain responses following one of the colour stimuli (placebo) and for high pain responses following the other colour stimuli (non-placebo). Moreover, they were punished when their pain responses were high following placebo stimuli and low following non-placebo stimuli. To investigate the role of contingency, that is dependent relation between rewards/punishers and pain responses, the random-control group received rewards and punishers in a non-contingent manner. The colour-control group did not receive any rewards or punishers to control for nonassociative learning. Pain intensity ratings were used as an outcome measure, and verbal feedback on pain ratings was used as rewards/punishers. RESULTS When rewarding and punishment were stopped, only participants from the experimental group experienced less pain following the placebo than following the non-placebo stimuli; that is, placebo analgesia was found in this group. This effect was not extinguished during the study. CONCLUSIONS Placebo analgesia can be induced by operant conditioning, which should be considered a third mechanism for producing placebo effects. Moreover, the contingency between pain responses and rewards/punishers is crucial to induce placebo analgesia through operant conditioning. SIGNIFICANCE According to the current placebo literature, placebo analgesia can be explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. Our study reveals that patients can learn placebo analgesia as a result of operant conditioning, suggesting that randomized controlled trials could be improved by controlling the reinforcement that might occur spontaneously when patients interact with, for example, medical personnel.
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Affiliation(s)
- Wacław M Adamczyk
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.,Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | | | - Elżbieta A Bajcar
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
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Krypotos AM, Vervliet B, Engelhard IM. The validity of human avoidance paradigms. Behav Res Ther 2018; 111:99-105. [DOI: 10.1016/j.brat.2018.10.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/11/2018] [Accepted: 10/26/2018] [Indexed: 01/10/2023]
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Karos K, Alleva JM, Peters ML. Pain, Please: An Investigation of Sampling Bias in Pain Research. THE JOURNAL OF PAIN 2018. [DOI: 10.1016/j.jpain.2018.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Neige C, Mavromatis N, Gagné M, Bouyer LJ, Mercier C. Effect of movement-related pain on behaviour and corticospinal excitability changes associated with arm movement preparation. J Physiol 2018; 596:2917-2929. [PMID: 29855037 DOI: 10.1113/jp276011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Experimental pain or its anticipation influence motor preparation processes as well as upcoming movement execution, but the underlying physiological mechanisms remain unknown. Our results showed that movement-related pain modulates corticospinal excitability during motor preparation. In accordance with the pain adaptation theory, corticospinal excitability was higher when the muscle has an antagonist (vs. an agonist) role for the upcoming movement associated with pain. Anticipation of movement-related pain also affects motor initiation and execution, with slower movement initiation (longer reaction times) and faster movement execution compared to movements that do not evoke pain. These results confirm the implementation of protective strategies during motor preparation known to be relevant for acute pain, but which may potentially have detrimental long-term consequences and lead to the development of chronic pain. ABSTRACT When a movement repeatedly generates pain, we anticipate movement-related pain and establish self-protective strategies during motor preparation, but the underlying mechanisms remains poorly understood. The current study investigated the effect of movement-related pain anticipation on the modulation of behaviour and corticospinal excitability during the preparation of arm movements. Participants completed an instructed-delay reaction-time (RT) task consisting of elbow flexions and extensions instructed by visual cues. Nociceptive laser stimulations (unconditioned stimuli) were applied to the lateral epicondyle during movement execution in a specific direction (CS+) but not in the other (CS-), depending on experimental group. During motor preparation, transcranial magnetic stimulation was used to measure corticospinal excitability in the biceps brachii (BB). RT and peak end-point velocity were also measured. Neurophysiological results revealed an opposite modulation of corticospinal excitability in BB depending on whether it plays an agonist (i.e. flexion) or antagonist (i.e. extension) role for the CS+ movements (P < 0.001). Moreover, behavioural results showed that for the CS+ movements RT did not change relative to baseline, whereas the CS- movements were initiated more quickly (P = 0.023) and the CS+ flexion movements were faster relative to the CS- flexion movements (P < 0.001). This is consistent with the pain adaptation theory which proposes that in order to protect the body from further pain, agonist muscle activity is reduced and antagonist muscle activity is increased. If these strategies are initially relevant and lead to short-term pain alleviation, they may potentially have detrimental long-term consequences and lead to the development of chronic pain.
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Affiliation(s)
- Cécilia Neige
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada.,Department of Rehabilitation, Laval University, Québec, QC, Canada
| | - Nicolas Mavromatis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada.,Department of Rehabilitation, Laval University, Québec, QC, Canada
| | - Martin Gagné
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada.,Department of Rehabilitation, Laval University, Québec, QC, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada.,Department of Rehabilitation, Laval University, Québec, QC, Canada
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