The relationship between fear generalization and pain modulation: an investigation in healthy participants

Kristof Vandael, Michel Meulders, Celine Vanden Boer, Ann Meulders*

*Corresponding author for this work

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Abstract

Background and aims Pain-related fear and its subsequent generalization is key to the development and maintenance of chronic pain disability. Research has shown that pain-related fear acquired through classical conditioning generalizes following a gradient, that is, novel movements that are proprioceptively similar to the original pain-associated movement elicit more fear. Studies suggest that classical conditioning can also modulate pain and conditioned fear seems to mediate this effect. However, it remains uninvestigated whether this is also the case for generalized fear. Methods In a voluntary joystick movement paradigm, one movement (conditioned stimulus; CS+) was followed by pain (pain-US), and another was not (CS-). Generalization to five novel movements (generalization stimuli; GSs) with varying levels of similarity to the CSs was tested when paired with an at-pain-threshold intensity stimulus (threshold-USs). We collected self-reported fear and pain, as well as eyeblink startle responses as an additional index of conditioned fear. Results Results showed a fear generalization gradient in the ratings, but not in the startle measures. The data did not support the idea that fear generalization mediates spreading of pain. Conclusions Despite the lack of effects in the current study, this is a promising novel approach to investigate pain modulation in the context of chronic pain. Implications This study replicates the finding that pain-related fear spreads selectively towards movements that are proprioceptively more similar to the original pain-eliciting movement. Although results did not support the idea that such generalized fear mediates spreading of pain, the study provides a promising approach to investigate pain modulation by pain-associated movements.

Original languageEnglish
Pages (from-to)151-165
Number of pages15
JournalScandinavian Journal of Pain
Volume20
Issue number1
Early online date21 Aug 2019
DOIs
Publication statusPublished - Jan 2020

Keywords

  • ACQUISITION
  • AVOIDANCE MODEL
  • CHRONIC MUSCULOSKELETAL PAIN
  • CLASSICALLY-CONDITIONED RESPONSE
  • DEFICITS
  • EMOTION
  • EXPECTATIONS
  • EXTINCTION
  • FIBROMYALGIA
  • STARTLE
  • conditioned pain modulation
  • fear conditioning
  • fear generalization
  • pain report
  • pain-related fear

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