Memory bias for learned threat and safety cues in youth with chronic pain

Negatively-biased memories for painful events (recalled pain greater than initial reported pain) are consistently associated with worse pain outcomes in adults and youth; thus, the tendency to develop negative memory biases is suggested to be a risk factor for chronic pain. From a transdiagnostic perspective, this may reflect a more general bias in recalling threatening vs. safe stimuli; this has not yet been tested. Sixty-seven youth (N=43 chronic pain patients, mixed diagnoses; N=24 controls) completed a developmentally-appropriate fear conditioning task (the Screaming Lady) in which they rated their fear towards learned threat and safety cues. Patients completed self-report measures of pain catastrophizing (PCS-C), pain-related fear-avoidance (FOPQ-C, fear and avoidance subscales), and physical functioning (FDI). Two months later (M=59 days), youth rated their recalled fear towards the threat and safety stimuli. For a subsample (N=32, 23 patients), their open-ended recall of the stimuli were coded. T-tests examined patient-control differences in memory biases. Partial correlations controlled for initial fear ratings to examine how memory biases covary with pain catastrophizing, fear-avoidance, and functioning. Patients and controls did not significantly differ in their memory biases (p's > .05). Patients with higher pain catastrophizing (r = .415, p = .007) and greater pain-related fear (r = .363, p = .02) had greater negatively-biased recall of fear towards safety stimuli at follow-up; there was no association with functional disability. Youth with greater negatively-biased recall of fear towards threat stimuli described the stimulus’ appearance (r = .430, p = .018) and emotional expression (r = .506, p = .006) in greater detail. Negatively-biased recall of safety cues is related to higher pain catastrophizing and pain-related fear in youth with chronic pain. Mixed quantitative-qualitative probing of threat-related memories will be helpful to reveal how memory biases are a risk factor for pediatric chronic pain. NIH R01HD083270 to LE Simons.