Fear in the context of pain: Lessons learned from 100 years of fear conditioning research
- PMID:32417719
- DOI: 10.1016/j.brat.2020.103635
Fear in the context of pain: Lessons learned from 100 years of fear conditioning research
Abstract
Human fear conditioning research since Watson's case study on "Little Albert" has vastly evolved and its impact today is reaching far beyond phobic anxiety. This review focuses on how fear conditioning research, mainly using exteroceptive conditioned stimuli (CSs) and aversive, non-noxious stimuli as unconditioned stimuli (USs), has been extended and translated to chronic pain research. We describe the different pain-related fear conditioning paradigms using proprioceptive and interoceptive CSs and painful stimuli as USs that have been developed to study specific forms of pain-related fear (i.e. fear of movement, fear of touch, fear of visceral sensations, and fear of penetration) that are relevant for different chronic pain conditions (i.e. musculoskeletal pain, neuropathic pain, visceral pain, and genital pain). We present evidence that patients with chronic pain demonstrate impaired safety learning and excessive fear generalization; learning anomalies that have also been observed in anxiety disorders. Extinction-based protocols (exposure in vivo) have been developed to reduce pain-related fear and increase daily functioning in various chronic pain disorders. Finally, we outline some challenges and future directions to further our understanding of learning mechanisms underlying the development, persistence, and treatment of chronic pain disability.
Keywords: Acquisition; Classical conditioning; Exposure; Extinction; Generalization; Learning; Pain; Pain-related fear.
Copyright © 2020 The Author. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare no conflict of interest.
Similar articles
- Learning pain-related fear: neural mechanisms mediating rapid differential conditioning, extinction and reinstatement processes in human visceral pain.Gramsch C, Kattoor J, Icenhour A, Forsting M, Schedlowski M, Gizewski ER, Elsenbruch S.Gramsch C, et al.Neurobiol Learn Mem. 2014 Dec;116:36-45. doi: 10.1016/j.nlm.2014.08.003. Epub 2014 Aug 13.Neurobiol Learn Mem. 2014.PMID:25128878
- Extinction of Fear Generalization: A Comparison Between Fibromyalgia Patients and Healthy Control Participants.Meulders A, Meulders M, Stouten I, De Bie J, Vlaeyen JW.Meulders A, et al.J Pain. 2017 Jan;18(1):79-95. doi: 10.1016/j.jpain.2016.10.004. Epub 2016 Oct 22.J Pain. 2017.PMID:27776989
- The effect of threat information on acquisition, extinction, and reinstatement of experimentally conditioned fear of movement-related pain.den Hollander M, Meulders A, Jakobs M, Vlaeyen JW.den Hollander M, et al.Pain Med. 2015 Dec;16(12):2302-15. doi: 10.1111/pme.12836. Epub 2015 Sep 11.Pain Med. 2015.PMID:26360518Clinical Trial.
- Fear reduction in patients with chronic pain: a learning theory perspective.den Hollander M, de Jong JR, Volders S, Goossens ME, Smeets RJ, Vlaeyen JW.den Hollander M, et al.Expert Rev Neurother. 2010 Nov;10(11):1733-45. doi: 10.1586/ern.10.115.Expert Rev Neurother. 2010.PMID:20977330Review.
- Understanding fear of pain in chronic pain: interoceptive fear conditioning as a novel approach.De Peuter S, Van Diest I, Vansteenwegen D, Van den Bergh O, Vlaeyen JW.De Peuter S, et al.Eur J Pain. 2011 Oct;15(9):889-94. doi: 10.1016/j.ejpain.2011.03.002. Epub 2011 Mar 25.Eur J Pain. 2011.PMID:21440472Review.
Cited by
- Electrophysiological markers for anticipatory processing of nocebo-augmented pain.Blythe JS, Peerdeman KJ, Veldhuijzen DS, Karch JD, Evers AWM.Blythe JS, et al.PLoS One. 2023 Jul 26;18(7):e0288968. doi: 10.1371/journal.pone.0288968. eCollection 2023.PLoS One. 2023.PMID:37494313Free PMC article.
- Associative learning and extinction of conditioned threat predictors across sensory modalities.Koenen LR, Pawlik RJ, Icenhour A, Petrakova L, Forkmann K, Theysohn N, Engler H, Elsenbruch S.Koenen LR, et al.Commun Biol. 2021 May 11;4(1):553. doi: 10.1038/s42003-021-02008-1.Commun Biol. 2021.PMID:33976383Free PMC article.
- Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery-a study protocol of a randomized feasibility study.Karlsson E, Hanafi R, Brisby H, Fors A, Kemani M, Hedman H, Nijs J, Lundberg M.Karlsson E, et al.Pilot Feasibility Stud. 2024 Jan 26;10(1):16. doi: 10.1186/s40814-023-01433-9.Pilot Feasibility Stud. 2024.PMID:38279131Free PMC article.
- Corticotropin-releasing hormone neurons control trigeminal neuralgia-induced anxiodepression via a hippocampus-to-prefrontal circuit.Lv SS, Lv XJ, Cai YQ, Hou XY, Zhang ZZ, Wang GH, Chen LQ, Lv N, Zhang YQ.Lv SS, et al.Sci Adv. 2024 Jan 19;10(3):eadj4196. doi: 10.1126/sciadv.adj4196. Epub 2024 Jan 19.Sci Adv. 2024.PMID:38241377Free PMC article.
- Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome.Alaiti RK, Caneiro JP, Gasparin JT, Chaves TC, Malavolta EA, Gracitelli MEC, Meulders A, da Costa MF.Alaiti RK, et al.Pain Rep. 2021 Dec 16;6(4):e980. doi: 10.1097/PR9.0000000000000980. eCollection 2021 Nov-Dec.Pain Rep. 2021.PMID:34938935Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical