Learning and conditioning in chronic pain

This chapter highlights the ways that individuals learn to adapt to changes due to painful experiences. Learning is the observable change in behavior due to events in the internal and external environment, and it includes non-associative (habituation and sensitization) and associative learning (Pavlovian and operant conditioning). Once acquired, new knowledge representations remain stored in memory and may generalize to perceptually or functionally similar events. Moreover, these processes are not just a consequence of pain; they may also modulate the perception of pain. In contrast to the rapid acquisition of learned responses, their extinction is slow, fragile, and context-dependent, and it only occurs through inhibitory processes. The chapter reviews features of associative forms of learning in humans that contribute to pain, pain-related distress, and disability. It concludes with a discussion of promising future directions.