When Pain Meets… Pain-Related Choice Behavior and Pain Perception in Different Goal Conflict Situations

  • Martien G.S. Schrooten
    Address reprint requests to Martien G. S. Schrooten, PhD, Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Fakultetsgatan 1, 701 82 Örebro, Sweden.
    Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden

    Research Group on Health Psychology, University of Leuven, Leuven, Belgium
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  • Katja Wiech
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium

    Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Nuffield Division Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom

    Centre for Pain Research, University of Bath, Bath, United Kingdom
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  • Johan W.S. Vlaeyen
    Research Group on Health Psychology, University of Leuven, Leuven, Belgium

    Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
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Published:September 13, 2014DOI:


      • Healthy volunteers made choices between incompatible pain-related alternatives.
      • Alternatives differed in their (un)desirable effect on pain and money probability.
      • Choice latency and switching related positively to conflict and decision difficulty.
      • Choice switching related to threat/fear and affect in avoidance-avoidance conflicts.
      • Associations between choice behavior, pain, and affect depend on conflict situation.


      Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation.


      We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain treatment.

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