An experimental investigation into the mediating role of pain-related fear in boosting nocebo hyperalgesia

Mia Athina Thomaidou*, Dieuwke Swaantje Veldhuijzen, Ann Meulders, Andrea Walburga Maria Evers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)

Abstract

Nocebo hyperalgesia refers to increases in perceived pain that putatively result from negative expectations regarding a nocebo stimulus (eg, an inert treatment, compared with no treatment). The precise cognitive-emotional factors contributing to the origins of nocebo effects are poorly understood. We aimed to test the effects of experimentally induced pain-related fear on the acquisition and extinction of nocebo hyperalgesia in healthy participants (N = 72). Acquisition and extinction of nocebo hyperalgesia were compared between a group receiving standard nocebo conditioning (Control group) and 2 groups receiving distinct fear inductions: high intensity of pain stimulations (High-pain group) or a threat manipulation (High-threat group). During nocebo acquisition, the Control and High-threat groups were administered thermal pain stimulations of moderate intensity paired with sham electrical stimulation (nocebo trials), whereas high pain intensity was administered to the High-pain group. During extinction, equivalent pain intensities were administered across all trials. Pain-related fear was measured by eyeblink startle electromyography and self-report. Nocebo hyperalgesia occurred in all groups. Nocebo effects were significantly larger in the High-pain group than those in the Control group. This effect was mediated by self-reported fear, but not by fear-potentiated startle. Groups did not differ in the extinction rate. However, only the High-pain group maintained significant nocebo responses at the end of extinction. Anticipatory pain-related fear induced through a threat manipulation did not amplify nocebo hyperalgesia. These findings suggest that fear of high pain may be a key contributor to the amplification of nocebo hyperalgesia, only when high pain is experienced and not when it is merely anticipated.

Original languageEnglish
Pages (from-to)287-299
Number of pages13
JournalPain
Volume162
Issue number1
Early online date28 Jul 2020
DOIs
Publication statusPublished - Jan 2021

Keywords

  • Pain
  • Nocebo hyperalgesia
  • Fear
  • Conditioning
  • Negative suggestions
  • Learning
  • Expectations
  • MOVEMENT-RELATED PAIN
  • NEURAL MECHANISMS
  • VISCERAL PAIN
  • PLACEBO
  • ANXIETY
  • STARTLE
  • EXPECTATION
  • DISTINCTION
  • ACQUISITION
  • EXTINCTION

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