Highlights
- •Contingency learning is impaired in chronic hand pain patients.
- •Particularly, the formation of safety beliefs, but not threat beliefs, is disrupted.
- •In patients, threat beliefs spread to a wider range of novel but similar stimuli.
Abstract
Contingency learning, in particular the formation of danger beliefs, underpins conditioned
fear and avoidance behavior, yet equally important is the formation of safety beliefs.
That is, when threat beliefs and accompanying fear/avoidance spread to technically
safe cues, it might cause disability. Indeed, such overgeneralization has been advanced
as a transdiagnostic pathologic marker, but it has not been investigated in chronic
pain. Using a novel hand pain scenario contingency learning task, we tested the hypotheses
that chronic hand pain patients demonstrate less differential pain expectancy judgments
because of poor safety learning and demonstrate broader generalization gradients than
healthy controls. Participants viewed digitized 3-dimensional hands in different postures
presented in random order (conditioned stimulus [CS]) and rated the likelihood that
a fictive patient would feel pain when moving the hand into that posture. Subsequently,
the outcome (pain/no pain) was presented on the screen. One hand posture was followed
by pain (CS+), another was not (CS−). Generalization was tested using novel hand postures
(generalization stimuli) that varied in how similar they were to the original conditioned
stimuli. Patients, but not healthy controls, demonstrated a contingency learning deficit
determined by impaired safety learning, but not by exaggerated pain expectancy toward
the CS+. Patients showed flatter, asymmetric generalization gradients than the healthy
controls did, with higher pain expectancy for novel postures that were more similar
to the original CS−. The results clearly uphold our hypotheses and suggest that contingency
learning deficits might be important in the development and maintenance of the chronic
pain–related disability.
Perspective
Chronic hand pain patients demonstrate 1) reduced differential contingency learning
determined by a lack of safety belief formation, but not by exaggerated threat belief
formation, and 2) flatter, asymmetric generalization gradients than the healthy controls.
Key words
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Article info
Publication history
Published online: July 25, 2014
Accepted:
July 8,
2014
Received in revised form:
July 3,
2014
Received:
December 21,
2013
Footnotes
A.M. is a postdoctoral researcher of the Research Foundation Flanders (FWO-Vlaanderen), Belgium (12E33714N). The study was also supported by the Odysseus Grant “The Psychology of Pain and Disability Research Program” funded by the Research Foundation Flanders (FWO-Vlaanderen), Belgium, to J.W.S.V. (G090208N) and by an EFIC-Grünenthal Research Grant to A.M. G.L.M. is supported by the National Health and Medical Research Council of Australia (ID 1061279). This work was also supported by National Health and Medical Research Council grant (ID 1047317).
The authors report no conflict of interest.
The data in this study were presented at the symposium on “Recent Developments in Understanding and Treating Chronic Pain: From Fundamental Research to Novel Targets for Treatment” at the 43rd European Association for Behavioural and Cognitive Therapies (EABCT), Marrakech, Morocco, September 2013, and at PainAdelaide, Adelaide, Australia, March 2014.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
