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

Ann Meulders*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

42 Citations (Web of Science)

Abstract

Human fear conditioning research since Watson's case study on "Little Albert" has vastly evolved and its impact today is reaching far beyond phobic anxiety. This review focuses on how fear conditioning research, mainly using exteroceptive conditioned stimuli (CSs) and aversive, non-noxious stimuli as unconditioned stimuli (USs), has been extended and translated to chronic pain research. We describe the different pain-related fear conditioning paradigms using proprioceptive and interoceptive CSs and painful stimuli as USs that have been developed to study specific forms of pain-related fear (i.e. fear of movement, fear of touch, fear of visceral sensations, and fear of penetration) that are relevant for different chronic pain conditions (i.e. musculoskeletal pain, neuropathic pain, visceral pain, and genital pain). We present evidence that patients with chronic pain demonstrate impaired safety learning and excessive fear generalization; learning anomalies that have also been observed in anxiety disorders. Extinction-based protocols (exposure in vivo) have been developed to reduce pain-related fear and increase daily functioning in various chronic pain disorders. Finally, we outline some challenges and future directions to further our understanding of learning mechanisms underlying the development, persistence, and treatment of chronic pain disability.

Original languageEnglish
Article number103635
Number of pages14
JournalBehaviour Research and Therapy
Volume131
Early online date30 Apr 2020
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Pain
  • Pain-related fear
  • Learning
  • Classical conditioning
  • Acquisition
  • Generalization
  • Extinction
  • Exposure
  • LOW-BACK-PAIN
  • MOVEMENT-RELATED PAIN
  • CHRONIC MUSCULOSKELETAL PAIN
  • IRRITABLE-BOWEL-SYNDROME
  • LONG-TERM OUTCOMES
  • EXPOSURE IN-VIVO
  • AVOIDANCE MODEL
  • POSITIVE AFFECT
  • MUSCULAR RESPONSES
  • ANXIETY DISORDERS

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