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

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

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus [CS+]) originally associated with pain (unconditioned stimulus), but expands to similar movements (generalization stimuli [GSs]). This spreading of fear becomes dysfunctional when overgeneralization to safe stimuli occurs. More importantly, persistence of pain-related fear to GSs despite corrective feedback might even be more debilitating and maintain long-term chronic pain disability. Yet, research on this topic is lacking. Using a voluntary joystick movement paradigm, we examined (extinction of) pain-related fear generalization in fibromyalgia patients (FM) and healthy control participants (HC). During acquisition, one movement (CS+) predicted pain; another did not (CS-). We tested (extinction of) fear generalization to 5 GSs varying in similarity with the CS+ and CS-. Results revealed flatter pain expectancy generalization gradients in FM than in HC due to elevated responses to GSs more similar to the CS-; the fear generalization gradients did not differ. Although pain-related fear and expectancy to the GSs decreased during extinction, responses to the GSs remained higher for FM than HC, suggesting that extinction of generalization is impaired in chronic pain patients. Persistence of excessive protective responses may contribute to maintaining long-term chronic pain disability.

PERSPECTIVE: Pain-related fear and expectancy to movements-varying in similarity with the original painful and nonpainful movement-decrease during extinction in HC and FM. Yet, conditioned responses remain elevated in patients despite corrective feedback, indicating impaired extinction of generalization. Persistent excessive protective responses may contribute to preserving pain disability.

Original languageEnglish
Pages (from-to)79-95
Number of pages17
JournalThe Journal of Pain
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 2017

Keywords

  • ACQUISITION
  • CONDITIONED FEAR
  • DEPRESSION SCALE
  • EFFECT SIZE
  • HOSPITAL ANXIETY
  • HUMANS
  • MOVEMENT-RELATED PAIN
  • PANIC DISORDER
  • POTENTIATED STARTLE
  • Pain-related fear
  • QUESTIONNAIRE
  • fear conditioning
  • fear extinction
  • fear generalization
  • fibromyalgia
  • learning
  • voluntary movement paradigm

Cite this

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title = "Extinction of Fear Generalization: A Comparison Between Fibromyalgia Patients and Healthy Control Participants",
abstract = "Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus [CS+]) originally associated with pain (unconditioned stimulus), but expands to similar movements (generalization stimuli [GSs]). This spreading of fear becomes dysfunctional when overgeneralization to safe stimuli occurs. More importantly, persistence of pain-related fear to GSs despite corrective feedback might even be more debilitating and maintain long-term chronic pain disability. Yet, research on this topic is lacking. Using a voluntary joystick movement paradigm, we examined (extinction of) pain-related fear generalization in fibromyalgia patients (FM) and healthy control participants (HC). During acquisition, one movement (CS+) predicted pain; another did not (CS-). We tested (extinction of) fear generalization to 5 GSs varying in similarity with the CS+ and CS-. Results revealed flatter pain expectancy generalization gradients in FM than in HC due to elevated responses to GSs more similar to the CS-; the fear generalization gradients did not differ. Although pain-related fear and expectancy to the GSs decreased during extinction, responses to the GSs remained higher for FM than HC, suggesting that extinction of generalization is impaired in chronic pain patients. Persistence of excessive protective responses may contribute to maintaining long-term chronic pain disability.PERSPECTIVE: Pain-related fear and expectancy to movements-varying in similarity with the original painful and nonpainful movement-decrease during extinction in HC and FM. Yet, conditioned responses remain elevated in patients despite corrective feedback, indicating impaired extinction of generalization. Persistent excessive protective responses may contribute to preserving pain disability.",
keywords = "ACQUISITION, CONDITIONED FEAR, DEPRESSION SCALE, EFFECT SIZE, HOSPITAL ANXIETY, HUMANS, MOVEMENT-RELATED PAIN, PANIC DISORDER, POTENTIATED STARTLE, Pain-related fear, QUESTIONNAIRE, fear conditioning, fear extinction, fear generalization, fibromyalgia, learning, voluntary movement paradigm",
author = "Ann Meulders and Michel Meulders and Iris Stouten and {De Bie}, Jozef and Vlaeyen, {Johan W S}",
note = "Copyright {\circledC} 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.",
year = "2017",
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language = "English",
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Extinction of Fear Generalization : A Comparison Between Fibromyalgia Patients and Healthy Control Participants. / Meulders, Ann; Meulders, Michel; Stouten, Iris; De Bie, Jozef; Vlaeyen, Johan W S.

In: The Journal of Pain, Vol. 18, No. 1, 01.2017, p. 79-95.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Extinction of Fear Generalization

T2 - A Comparison Between Fibromyalgia Patients and Healthy Control Participants

AU - Meulders, Ann

AU - Meulders, Michel

AU - Stouten, Iris

AU - De Bie, Jozef

AU - Vlaeyen, Johan W S

N1 - Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

PY - 2017/1

Y1 - 2017/1

N2 - Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus [CS+]) originally associated with pain (unconditioned stimulus), but expands to similar movements (generalization stimuli [GSs]). This spreading of fear becomes dysfunctional when overgeneralization to safe stimuli occurs. More importantly, persistence of pain-related fear to GSs despite corrective feedback might even be more debilitating and maintain long-term chronic pain disability. Yet, research on this topic is lacking. Using a voluntary joystick movement paradigm, we examined (extinction of) pain-related fear generalization in fibromyalgia patients (FM) and healthy control participants (HC). During acquisition, one movement (CS+) predicted pain; another did not (CS-). We tested (extinction of) fear generalization to 5 GSs varying in similarity with the CS+ and CS-. Results revealed flatter pain expectancy generalization gradients in FM than in HC due to elevated responses to GSs more similar to the CS-; the fear generalization gradients did not differ. Although pain-related fear and expectancy to the GSs decreased during extinction, responses to the GSs remained higher for FM than HC, suggesting that extinction of generalization is impaired in chronic pain patients. Persistence of excessive protective responses may contribute to maintaining long-term chronic pain disability.PERSPECTIVE: Pain-related fear and expectancy to movements-varying in similarity with the original painful and nonpainful movement-decrease during extinction in HC and FM. Yet, conditioned responses remain elevated in patients despite corrective feedback, indicating impaired extinction of generalization. Persistent excessive protective responses may contribute to preserving pain disability.

AB - Fear learning deficiencies might contribute to the development and maintenance of chronic pain disability. Fear is often not restricted to movements (conditioned stimulus [CS+]) originally associated with pain (unconditioned stimulus), but expands to similar movements (generalization stimuli [GSs]). This spreading of fear becomes dysfunctional when overgeneralization to safe stimuli occurs. More importantly, persistence of pain-related fear to GSs despite corrective feedback might even be more debilitating and maintain long-term chronic pain disability. Yet, research on this topic is lacking. Using a voluntary joystick movement paradigm, we examined (extinction of) pain-related fear generalization in fibromyalgia patients (FM) and healthy control participants (HC). During acquisition, one movement (CS+) predicted pain; another did not (CS-). We tested (extinction of) fear generalization to 5 GSs varying in similarity with the CS+ and CS-. Results revealed flatter pain expectancy generalization gradients in FM than in HC due to elevated responses to GSs more similar to the CS-; the fear generalization gradients did not differ. Although pain-related fear and expectancy to the GSs decreased during extinction, responses to the GSs remained higher for FM than HC, suggesting that extinction of generalization is impaired in chronic pain patients. Persistence of excessive protective responses may contribute to maintaining long-term chronic pain disability.PERSPECTIVE: Pain-related fear and expectancy to movements-varying in similarity with the original painful and nonpainful movement-decrease during extinction in HC and FM. Yet, conditioned responses remain elevated in patients despite corrective feedback, indicating impaired extinction of generalization. Persistent excessive protective responses may contribute to preserving pain disability.

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KW - EFFECT SIZE

KW - HOSPITAL ANXIETY

KW - HUMANS

KW - MOVEMENT-RELATED PAIN

KW - PANIC DISORDER

KW - POTENTIATED STARTLE

KW - Pain-related fear

KW - QUESTIONNAIRE

KW - fear conditioning

KW - fear extinction

KW - fear generalization

KW - fibromyalgia

KW - learning

KW - voluntary movement paradigm

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DO - 10.1016/j.jpain.2016.10.004

M3 - Article

C2 - 27776989

VL - 18

SP - 79

EP - 95

JO - The Journal of Pain

JF - The Journal of Pain

SN - 1526-5900

IS - 1

ER -