Words putting pain in motion: the generalization of pain-related fear within an artificial stimulus category

Marc P Bennett, Ann Meulders, Frank Baeyens, Johan W S Vlaeyen, Marc P Bennett, Ann Meulders, Frank Baeyens, Johan W S Vlaeyen

Abstract

Patients with chronic pain are often fearful of movements that never featured in painful episodes. This study examined whether a neutral movement's conceptual relationship with pain-relevant stimuli could precipitate pain-related fear; a process known as symbolic generalization. As a secondary objective, we also compared experiential and verbal fear learning in the generalization of pain-related fear. We conducted an experimental study with 80 healthy participants who were recruited through an online experimental management system (M age = 23.04 years, SD = 6.80 years). First, two artificial categories were established wherein nonsense words and joystick arm movements were equivalent. Using a between-groups design, nonsense words from one category were paired with either an electrocutaneous stimulus (pain-US) or threatening information, while nonsense words from the other category were paired with no pain-US or safety information. During a final testing phase, participants were prompted to perform specific joystick arm movements that were never followed by a pain-US, although they were informed that it could occur. The results showed that movements equivalent to the pain-relevant nonsense words evoked heightened pain-related fear as measured by pain-US expectancy, fear of pain, and unpleasantness ratings. Also, experience with the pain-US evinced stronger acquisition and generalization compared to experience with threatening information. The clinical importance and theoretical implications of these findings are discussed.

Keywords: acceptance and commitment therapy; chronic pain disorders; fear-avoidance model; pain-related fear; symbolic generalization.

Figures

FIGURE 1
FIGURE 1
An overview of the shapes (A1 and A2), nonsense words (B1, B2, and B3) and joystick arm movements (C1, C2, and C3) that were used to establish two separate stimulus equivalence categories (A1 = B1 = C1 and A2 = B2 = C2).
FIGURE 2
FIGURE 2
A schematic overview of the matching-to-sample (MTS) task trials. The three different panels depict the trial formats for the different MTS phases; (1) training trials, (2) symmetry trials, and (3) equivalence trials. Within each panel is a depiction of the trials types found in a specific phase; training trial phase included [A→B] trials and [A→C] trials; symmetry trials included [B→A] trials and [C→A] trials; and equivalence trials included [B→C] trials and [C→B] trials.
FIGURE 3
FIGURE 3
(A) Mean unpleasantness ratings for the original CSs. This was a manipulation check to ensure complete conditioning. (B) Mean pain-US expectancy ratings for movements equivalent to the original CSs. (C) Mean fear of pain ratings for movements equivalent to the original CSs. (D) Mean unpleasantness ratings for movements equivalent to the original CSs. Error bars represent standard error. ∗p < 0.05.
FIGURE 4
FIGURE 4
Response latency as measured during the signaled joystick movement task: the mean response latency shown per block for each stimulus, and for both the pain-US group and instructed US group. Error bars represent standard error.

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