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Thomaidou MA, Blythe JS, Peerdeman KJ, van Laarhoven AIM, Van Schothorst MME, Veldhuijzen DS, Evers AWM. Learned Nocebo Effects on Cutaneous Sensations of Pain and Itch: A Systematic Review and Meta-analysis of Experimental Behavioral Studies on Healthy Humans. Psychosom Med 2023; 85:308-321. [PMID: 36961347 PMCID: PMC10171297 DOI: 10.1097/psy.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/24/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE In past decades, the field of nocebo research has focused on studying how sensory perception can be shaped by learning. Nocebo effects refer to aggravated sensory experiences or increased sensitivity to sensations such as pain and itch resulting from treatment-related negative experiences. Behavioral conditioning and verbal suggestions of a negative treatment outcome may aggravate pain and itch perception. Gaining a comprehensive view of the magnitude of nocebo effects and contributing factors will help steer nocebo research toward fruitful directions for understanding complex sensory phenomena. METHODS We conducted a systematic review and meta-analysis of a total of 37 distinct experimental nocebo studies on healthy participants (all published in English between 2008 and 2021), with four separate meta-analyses for nocebo effects on pain or itch. We conducted subgroup analyses and meta-regression on factors such as type and intensity of sensory stimuli, and length of conditioning paradigms. RESULTS This meta-analysis showed that, on average, effect sizes of nocebo effects were moderate to large (Hedges g between 0.26 and 0.71 for the four primary outcomes). The combination of conditioning and verbal suggestions yielded stronger nocebo responses on pain in particular. Subgroup analyses, including factors such as the type of sensory stimulation, did not explain the moderate heterogeneity in nocebo magnitudes between different studies. Risk of bias was generally low and was not related to nocebo magnitudes either. CONCLUSIONS We discuss these results in relation to the role of conditioning and aversive learning, and we recommend more consistency in designing and reporting nocebo experiments.
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Kragting M, Schuiling SF, Voogt L, Pool-Goudzwaard AL, Coppieters MW. Using Visual Feedback Manipulation in Virtual Reality to Influence Pain-Free Range of Motion in People with Nonspecific Neck Pain. Pain Pract 2020; 21:428-437. [PMID: 33251721 PMCID: PMC8048536 DOI: 10.1111/papr.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/04/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Background Based on associative learning theories it is hypothesized that pain might be a conditioned response. In people with musculoskeletal pain, the occurrence of movement‐induced pain might be a protective response, influenced by visual cues suggesting that the person is approaching a painful position. This study aimed to determine (1) whether the pain‐free range of motion (ROM) increased and decreased when visual feedback understated or overstated true rotation in people with neck pain and (2) whether this effect was more pronounced if pain was chronic. Method People with subacute and chronic nonspecific neck pain wore a VR‐headset and rotated their head to the left and right until the onset of pain. Visual feedback about the amount of movement was either equal, 20% less, or 20% greater than their actual rotation. Maximal pain‐free ROM was measured using the VR‐headset sensors. Data were analyzed using a mixed‐design ANOVA. Results There was no effect of visual feedback manipulation on pain‐free ROM (P = 0.13) and no interaction effect between the visual feedback condition and duration of pain (P = 0.86). Discussion The inability to influence pain‐free ROM by manipulating visual feedback in people with subacute or chronic neck pain does not support associative learning theories for the perception of neck pain.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan F Schuiling
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
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Traxler J, Madden VJ, Moseley GL, Vlaeyen JWS. Modulating pain thresholds through classical conditioning. PeerJ 2019; 7:e6486. [PMID: 30867984 PMCID: PMC6410694 DOI: 10.7717/peerj.6486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Classical conditioning has frequently been shown to be capable of evoking fear of pain and avoidance behavior in the context of chronic pain. However, whether pain itself can be conditioned has rarely been investigated and remains a matter of debate. Therefore, the present study investigated whether pain threshold ratings can be modified by the presence of conditioned non-nociceptive sensory stimuli in healthy participant. Methods In 51 healthy volunteers, pain threshold to electrocutaneous stimuli was determined prior to participation in a simultaneous conditioning paradigm. Participants underwent an acquisition phase in which one non-painful vibrotactile stimulus (CS+) was repeatedly paired with a painful electrocutaneous stimulus, whereas a second vibrotactile stimulus of the same quality and intensity (CS−) was paired with a non-painful electrocutaneous stimulus. Stimulation was provided on the lower back with close proximity between the conditioned stimulus and the unconditioned stimulus. In the test phase, electrocutaneous stimuli at the individually-set threshold intensity were simultaneously delivered together with either a CS+ or CS−. Pain intensity ratings were obtained after each trial; expectancy ratings were obtained after each block. The primary outcome was the percentage of test stimuli that were rated as painful. Results Test stimuli were more likely to be rated as painful when they were paired with the CS+ than when they were paired with the CS−. This effect was not influenced by contingency awareness, nor by expectancies or mood states. Discussion The findings support the notion that the judgement of an event being painful or non-painful can be influenced by classical conditioning and corroborate the possible role of associative learning in the development and maintenance of chronic pain.
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Affiliation(s)
- Juliane Traxler
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
| | - Victoria J Madden
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Mental Health, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - G Lorimer Moseley
- Body in Mind Research Group, University of South Australia, Adelaide, SA, Australia
| | - Johan W S Vlaeyen
- Research Centre for Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
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Harvie DS, Sterling M, Smith AD. Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality. Scand J Pain 2018; 18:525-532. [DOI: 10.1515/sjpain-2017-0165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain. This experiment aimed to determine whether contexts associated with pain, could modulate mechanical pain thresholds and pain intensity.
Methods
Forty-eight healthy participants underwent a contextual conditioning procedure, where three neutral virtual reality contexts were paired with either unpredictable noxious stimulation, unpredictable vibrotactile stimulation, or no stimulation. Following the conditioning procedure, mechanical pain thresholds and pain evoked by a test stimulus were examined in each context. In the test phase, the effect of expectancy was equalised across conditions by informing participants when thresholds and painful stimuli would be presented.
Results
Contrary to our hypothesis, scenes that were associated with noxious stimulation did not increase mechanical sensitivity (p=0.08), or increase pain intensity (p=0.46). However, an interaction with sex highlighted the possibility that pain-associated contexts may alter pain sensitivity in females but not males (p=0.03).
Conclusions
Overall, our data does not support the idea that pain-associated contexts can alter pain sensitivity in healthy asymptomatic individuals. That an effect was shown in females highlights the possibility that some subgroups may be susceptible to such an effect, although the magnitude of the effect may lack real-world significance. If pain-associated cues prove to have a relevant pain augmenting effect, in some subgroups, procedures aimed at extinguishing pain-related associations may have therapeutic potential.
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Affiliation(s)
- Daniel S. Harvie
- The Hopkins Centre, Menzies Health Institute Queensland , Griffith University , Southport QLD 4222, Gold Coast , Australia , Phone: +61418826254
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC CRE in Recovery Following Road Traffic Injury , University of Queensland , Brisbane , Australia
- Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| | - Ashley D. Smith
- Recover Injury Research Centre, NHMRC CRE in Recovery Following Road Traffic Injury , University of Queensland , Brisbane , Australia
- School of Allied Health Sciences , Griffith University , Gold Coast , Australia
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Biggs EE, Meulders A, Kaas AL, Goebel R, Vlaeyen JWS. The Acquisition and Extinction of Fear of Painful Touch: A Novel Tactile Fear Conditioning Paradigm. THE JOURNAL OF PAIN 2017; 18:1505-1516. [PMID: 28842367 DOI: 10.1016/j.jpain.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Emma E Biggs
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Ann Meulders
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Center for Excellence Generalization on Research in Health and Psychopathology, University of Leuven, Leuven, Belgium
| | - Amanda L Kaas
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neuroimaging and Neuromodeling, Netherlands Institute for Neuroscience, An institute of the Royal Netherlands Academy of Art and Sciences (KNAW), The Netherlands
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Center for Excellence Generalization on Research in Health and Psychopathology, University of Leuven, Leuven, Belgium
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