Mere Intention to Perform Painful Movements Elicits Fear of Movement-Related Pain: An Experimental Study on Fear Acquisition Beyond Actual Movements

A. Meulders, J.W.S. Vlaeyen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Fresh empirical evidence supports the notion that fear of movement-related pain can be acquired through associative learning. In the context of these findings, 2 ideas are appealing, yet uninvestigated. The first is that merely the intention to perform a painful movement acts as a covert conditioned stimulus (CS) inducing defensive fear responses (ie, gaining excitatory properties following Pavlovian acquisition). The second idea is that after extinction, fear of movement-related pain can easily be reinstated after unexpected painful stimuli (ie, reinstatement). In a voluntary differential conditioning movement paradigm with movements as CSs and a painful electrocutaneous stimulus as the unconditioned stimulus (pain-US), 2 groups were included (Experimental/Control). One movement (CS+) was followed by the pain-US and another movement (CS) was not during acquisition, while the CS+ was no longer reinforced during extinction. Next, the Experimental group received 2 reinstating pain-USs, whereas the Control group did not. The CS+ but not the CS evoked fear of movement-related pain in self-reports and eye-blink startles. Intriguingly, the mere intention to perform the painful movement produced higher eye-blink startle responses than the intention to perform the nonpainful movement. We also demonstrated nondifferential reinstatement in the verbal fear ratings in the Experimental group only. Perspective: This study demonstrates that the mere intention to perform a painful movement prior to the actual painful movement itself can come to elicit conditioned fear responses. These results suggest that actual movement may not be necessary to elicit pain-related fear responses, maintaining chronic pain-related fear, avoidance, and disability. (C) 2013 by the American Pain Society
Original languageEnglish
Pages (from-to)412-423
Number of pages12
JournalThe Journal of Pain
Volume14
Issue number4
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Fear conditioning
  • fear of movement-related pain
  • motor intention
  • reinstatement
  • voluntary movement paradigm
  • CHRONIC MUSCULOSKELETAL PAIN
  • CONDITIONED FEAR
  • BACK-PAIN
  • AVOIDANCE MODEL
  • REINSTATEMENT
  • EXTINCTION
  • PARADIGM
  • STIMULUS
  • CONTEXT
  • INTERFERENCE

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