The influence of pain-related expectations on intensity perception of non-painful somatosensory stimuli

Jonas Zaman*, Katja Wiech, Nathalie Claes, Lukas Van Oudenhove, Ilse Van Diest, Johan W. S. Vlaeyen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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OBJECTIVE: The extent to which pain-related expectations, known to affect pain perception, also affect perception of non-painful sensations remains unclear, as well as the potential role of unpredictability in this context.

METHODS: In a proprioceptive fear conditioning paradigm, various arm extension movements were associated with predictable and unpredictable electrocutaneous pain or its absence. During a subsequent test phase non-painful electrocutaneous stimuli with a high or low intensity were presented during movement execution. We used hierarchical drift diffusion modeling to examine the influence of expecting pain on the perceptual decision-making process underlying intensity perception of non-painful sensations. In the first experiment (n=36), the pain stimulus was never presented during the test phase after conditioning. In the second experiment (n=39), partial reinforcement was adopted to prevent extinction of pain expectations.

RESULTS: In both experiments, movements that were associated with (un)predictable pain led to higher pain-expectancy, self-reported fear, unpleasantness and arousal, as compared to movements that were never paired with pain (effect sizes ηp ranging from .119 - .557; all p-values < .05). Only in the second experiment - when the threat of the pain US remained present - we found that the expectation of pain affected decision-making. Compared to the no pain condition, an a priori decision-making bias towards the high intensity decision threshold was found with the strongest bias during unpredictable pain (effect sizes ηp ranging from .469 - .504; all p-values < .001).

CONCLUSIONS: Thus, the expectation of pain not only affects inferential processes for subsequent painful but also for non-painful bodily stimuli, with unpredictability moderating these effects, and only when the threat of pain remains present due to partial reinforcement.

Original languageEnglish
Pages (from-to)836–844
Number of pages9
JournalPsychosomatic Medicine
Issue number9
Early online date3 Apr 2018
Publication statusPublished - Nov 2018


  • pain
  • expectation
  • associative fear learning
  • unpredictability
  • hierarchical drift diffusion model
  • FEAR

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