Highlights
- •Touch that is associated with pain in a predictable pain context induces cued fear.
- •Touch in an unpredictable pain context induces cued as well as contextual fear.
- •Both types of fear of touch can be successfully reduced using extinction protocols.
- •Fear of touch is a debilitating symptom in many chronic pain conditions.
- •Tactile conditioning can be a valuable tool for studying fear of touch.
Abstract
Fear of touch, due to allodynia and spontaneous pain, is not well understood. Experimental
methods to advance this topic are lacking, and therefore we propose a novel tactile
conditioning paradigm. Seventy-six pain-free participants underwent acquisition in
a predictable as well as an unpredictable pain context. In the predictable context,
vibrotactile stimulation was paired with painful electrocutaneous stimulation (simulating
allodynia). In the unpredictable context, vibrotactile stimulation was unpaired with
pain (simulating spontaneous pain). During an extinction phase, a cue exposure and
context exposure group continued in the predictable and unpredictable context, respectively,
without pain. A control group received continued acquisition in both contexts. Self-reported
fear and skin conductance responses, but not startle responses, showed fear of touch
was acquired in the predictable context. Context-related startle responses showed
contextual fear emerged in the unpredictable context, together with elevated self-reported
fear and skin conductance responses evoked by the unpaired vibrotactile stimulations.
Cue exposure reduced fear of touch, whereas context exposure reduced contextual fear.
Thus, painful touch leads to increased fear, as does touch in the same context as
unpredictable pain, and extinction protocols can reduce this fear. We conclude that
tactile conditioning is valuable for investigating fear of touch and can advance our
understanding of chronic pain.
Perspectives
The acquisition and extinction of fear of touch was investigated in a clinical analog
study using a novel tactile fear conditioning paradigm. The results have implications
for research on the development and treatment of chronic pain conditions characterized
by allodynia and spontaneous pain fluctuations.
Key words
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Article info
Publication history
Published online: August 22, 2017
Accepted:
August 10,
2017
Received in revised form:
August 4,
2017
Received:
June 6,
2017
Footnotes
Disclosures: This work was supported by the Research Foundation Flanders, Belgium (FWO Vlaanderen; 11T3616N and 12E3717N) and the “Asthenes” long-term structural funding–Methusalem grant by the Flemish Government, Belgium (METH/15/011). The authors report no conflict of interest.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2017 by the American Pain Society
