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.
Key words
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Article info
Publication history
Published online: March 04, 2013
Accepted:
December 11,
2012
Received in revised form:
November 7,
2012
Received:
June 20,
2012
Footnotes
This study was supported by the Odysseus Grant—“The Psychology of Pain and Disability Research Program”— funded by the Research Foundation–Flanders, Belgium (FWO Vlaanderen).
The first author, on behalf of the other author, declares no financial or other relationship with a public or private institution which could involve a potential conflict of interest.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
