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

  • Ann Meulders
    Correspondence
    Address reprint requests to Ann Meulders, PhD, Department of Psychology, University of Leuven, Tiensestraat 102, box 3726, 3000 Leuven, Belgium.
    Affiliations
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium
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  • Johan W.S. Vlaeyen
    Affiliations
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium

    Center of Excellence Generalization Research in Ill Health and Psychopathology, University of Leuven, Leuven, Belgium

    Department of Clinical Psychological Science, Maastricht University, The Netherlands
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      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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      References

        • Blumenthal T.D.
        • Cuthbert B.N.
        • Filion D.L.
        • Hackley S.
        • Lipp O.V.
        • Van Boxtel A.
        Committee report: Guidelines for human startle eyeblink electromyographic studies.
        Psychophysiology. 2005; 42: 1-15
        • Bouton M.E.
        Differential control by context in the inflation and reinstatement paradigms.
        J Exp Psychol: Anim Behav Process. 1984; 10: 56-74
        • Bouton M.E.
        Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. [Review].
        Psychol Bull. 1993; 114: 80-99
        • Bouton M.E.
        Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction.
        Biol Psychiat. 2002; 52: 976-986
        • Bouton M.E.
        Context and behavioral processes in extinction.
        Learn Memory. 2004; 11: 485-494
        • Bouton M.E.
        • Bolles R.C.
        Contextual control of the extinction of conditioned fear.
        Learn Motiv. 1979; 10: 445-466
        • Christiansen S.
        • Oettingen G.
        • Dahme B.
        • Klinger R.
        A short goal-pursuit intervention to improve physical capacity: A randomized clinical trial in chronic back pain patients.
        Pain. 2010; 149: 444-452
        • De Clercq A.
        • Verschuere B.
        • De Vlieger P.
        • Crombez G.
        Psychophysiological analysis (PSPHA): a modular script based program for analyzing psychophysiological data.
        Behav Res Meth. 2006; 38: 504-510
        • Delamater A.R.
        Selective reinstatement of stimulus-outcome associations.
        Anim Learn Behav. 1997; 25: 400-412
        • Dirikx T.
        • Hermans D.
        • Vansteenwegen D.
        • Baeyens F.
        • Eelen P.
        Reinstatement of extinguished conditioned responses and negative stimulus valence as a pathway to return of fear in humans.
        Learn Memory. 2004; 11: 549-554
        • Dirikx T.
        • Hermans D.
        • Vansteenwegen D.
        • Baeyens F.
        • Eelen P.
        Reinstatement of conditioned responses in human differential fear conditioning.
        J Behav Ther Exp Psychiat. 2007; 38: 237-251
        • Dirikx T.
        • Vansteenwegen D.
        • Eelen P.
        • Hermans D.
        Non-differential return of fear in humans after a reinstatement procedure.
        Acta Psychol. 2009; 130: 175-182
        • Holm S.
        A simple sequentially rejective multiple test procedure.
        Scand J Stat. 1979; 6: 65-70
        • Kori S.H.
        • Miller R.P.
        • Todd D.D.
        Kinisophobia: A new view of chronic pain behavior.
        Pain Manag. 1990; 3: 35-43
        • Leeuw M.
        • Goossens M.
        • Linton S.
        • Crombez G.
        • Boersma K.
        • Vlaeyen J.
        The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence.
        J Behav Med. 2007; 30: 77-94
        • Lissek S.
        • Rabin S.
        • Heller R.E.
        • Lukenbaugh D.
        • Geraci M.
        • Pine D.S.
        • Grillon C.
        Overgeneralization of conditioned fear as a pathogenic marker of panic disorder.
        Am J Psychiat. 2010; 167: 47-55
        • Meulders A.
        • Dirikx T.
        • Vansteenwegen D.
        • Hermans D.
        Non-selective return of online outcome-expectancy in a human contingency learning paradigm after a reinstatement procedure.
        in: Columbus A.M. Advances in Psychology Research, Vol.77. Nova Science Publishers Inc., New York, NY2011: 243-262
        • Meulders A.
        • Fannes S.
        • Van Diest I.
        • De Peuter S.
        • Vansteenwegen D.
        • Van den Bergh O.
        Resistance to extinction in an odor-CO2 inhalation paradigm with 20% CO2: Further evidence for a learning account of Multiple Chemical Sensitivity.
        J Psychosom Res. 2010; 68: 47-56
        • Meulders A.
        • Vansteenwegen D.
        • Vlaeyen J.W.S.
        The acquisition of fear of movement-related pain and associative learning: A novel pain-relevant human fear conditioning paradigm.
        Pain. 2011; 152: 2460-2469
        • Meulders A.
        • Vlaeyen J.W.S.
        Reduction of fear of movement-related pain and pain-related anxiety: An associative learning approach using a voluntary movement paradigm.
        Pain. 2012; 153: 1504-1513
        • Miller R.P.
        • Kori S.H.
        • Todd D.D.
        The Tampa Scale for Kinesophobia.
        Unpublished Report, Tampa, FL1991
        • Moseley G.L.
        • Nicholas M.K.
        • Hodges P.W.
        Does anticipation of back pain predispose to back trouble?.
        Brain. 2004; 127: 2339-2347
        • Moseley G.L.
        • Hodges P.W.
        Are the changes in postural control associated with low back pain caused by pain interference?.
        Clin J Pain. 2005; 21: 323-329
        • Moseley G.L.
        • Hodges P.W.
        Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble?.
        Behav Neurosci. 2006; 120: 474-476
        • Moseley L.G.
        • Zalucki N.
        • Birklein F.
        • Marinus J.
        • van Hilten J.J.
        • Luomajoki H.
        Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain.
        Arthritis Rheum. 2008; 59: 623-631
        • Norrholm S.D.
        • Jovanovic T.
        • Vervliet B.
        • Myers K.
        • Davis M.
        • Rothbaum B.O.
        • Duncan E.J.
        Conditioned fear extinction and reinstatement in a human fear-potentiated startle paradigm.
        Learn Memory. 2006; 13: 681-685
        • Perneger T.V.
        What's wrong with Bonferroni adjustments.
        Br Med J. 1998; 316: 1236-1238
        • Rescorla R.A.
        • Heth C.D.
        Reinstatement of fear to an extinguished conditioned stimulus.
        J Exp Psychol: Anim Behav Process. 1975; 104: 88-96
        • Schmajuk N.A.
        • Larrauri J.A.
        • LaBar K.S.
        Reinstatement of conditioned fear and the hippocampus: An attentional-associative model.
        Behav Brain Res. 2007; 177: 242-253
        • Spruyt A.
        • Clarysse J.
        • Vansteenwegen D.
        • Baeyens F.
        • Hermans D.
        Affect 4.0: A free software package for implementing psychological and psychophysiological experiments.
        Exp Psychol. 2010; 57: 36-45
        • Toni I.
        • Thoenissen D.
        • Zilles K.
        Movement preparation and motor intention.
        NeuroImage. 2001; 14: S110-S117
        • Van den Bergh O.
        • Stegen K.
        • Van Diest I.
        • Raes C.
        • Stulens P.
        • Eelen P.
        • Veulemans H.
        • Van de Woestijne K.
        • Nemery B.
        Acquisition and extinction of somatic symptoms in response to odours: a Pavlovian paradigm relevant to multiple chemical sensitivity.
        Occup Environ Med. 1999; 56: 295-301
        • Van den Bergh O.
        • Stegen K.
        • Van de Woestijne K.
        Learning to have psychosomatic complaints: Conditioning of respiratory behavior and somatic complaints in psychosomatic patients.
        Psychosom Med. 1997; 59: 13-23
        • Vlaeyen J.W.S.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Vlaeyen J.W.S.
        • Linton S.J.
        Fear-avoidance model of chronic musculoskeletal pain: 12 years on.
        Pain. 2012; 153: 1144-1147
        • Vogel E.H.
        • Brandon S.E.
        • Wagner A.R.
        Stimulus representation in SOP: II. An application to inhibition of delay.
        Behav Process. 2003; 62: 27-48
        • Westbrook R.F.
        • Iordanova M.
        • McNally G.
        • Richardson R.
        • Harris J.A.
        Reinstatement of fear to an extinguished conditioned stimulus: Two roles for context.
        J Exp Psychol: Anim Behav Process. 2002; 28: 97-110