The Neuroscience of Pain and Fear

The relationship between fear and pain is highly complex and there are many mechanisms that facilitate bidirectional influence. There are emotional, cognitive, behavioral, and psychophysiological factors that allow fear to modulate the experience of pain. In addition, the expectancy of pain as well as beliefs about pain can in turn influence fear. We review evidence that investigates the mechanisms underlying these interactions. Individual differences in fear of pain are also thought to play a pivotal role in the transition to, and maintenance of, chronic pain conditions. Thus we review the current state of the art about how fear of pain is acquired, generalized, and extinguished. We conclude that updating current models of the relationship between pain and fear with the generative model view of the brain-and emphasizing the role of certainty (or precision)-may provide an interesting avenue for future research.