Imprecise Visual Feedback About Hand Location Increases a Classically Conditioned Pain Expectancy Effect

Published:January 29, 2021DOI:


      • We induced a classical conditioning effect of a specific location on pain expectancy.
      • The increase in pain expectancy generalized to nearby, novel locations.
      • Rendering visual input imprecise during acquisition (training) resulted in greater pain expectancies, but did not change generalization.
      • Extinction of pain expectancy did not occur when visual input during training was imprecise.


      We tested the hypotheses that rendering sensory input about hand location imprecise increases a classically conditioned pain expectancy effect, increases generalization of the effect to novel locations and reduces extinction of the effect. Forty healthy volunteers performed movements with their right hand along predefined paths. Each path passed through 2 locations that were defined as either i) the conditioned stimulus (CS+; paired with a painful unconditioned stimulus), or ii) unpaired (CS−). During acquisition phase, participants watched their hand as they moved it. Participants were randomly allocated to an Imprecise group, for whom visual feedback of the hand was offset 30 to 50 mm from its true location, or a Precise group, for whom vision was not disrupted. In the test phase, participants moved their hands to 5 locations—the CS+, CS−, and 3 locations that lay between the 2 (“generalization stimuli”). Our primary hypothesis was supported—pain expectancy was greater at the CS+ location in the Imprecise group than in the Precise group (6.9 [SD = 1.9] vs 5.4 [SD = 2.5], P= .02). Pain expectancies generalized to novel locations similarly in both groups and there was no difference in extinction between groups. Our primary hypothesis was supported but our subsequent hypotheses were not.


      We conditioned pain expectancy at a certain location of one hand, even though most participants were unaware of the contingency. Conditioned pain expectancy was greater when sensory information about location was less precise. This adds support to the possibility that associative learning may play a role in the progression of an acute pain episode to a more generalized pain disorder.

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