期刊
JOURNAL OF PAIN
卷 16, 期 12, 页码 1353-1365出版社
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.jpain.2015.09.007
关键词
Fear of movement-related pain; fear learning; extinction; counterconditioning; chronic pain; fear-avoidance
资金
- Research Foundation Flanders (FWO-Vlaanderen), Belgium [ID: 12E33714N, ID: G091812N]
- EFIC-Grunenthal Research Grant [ID: 169518451]
- Veni Grant by the Netherlands Organization for Scientific Research [ID: 453-04-003]
- Odysseus Grant The Psychology of Pain and Disability Research Program - Research Foundation Flanders (FWO-Vlaanderen), Belgium [ID: G090208N]
Cognitive-behavioral treatments for chronic pain typically target pain-related fear; exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a voluntary joystick movement paradigm. Participants were randomly allocated to the counterconditioning or extinction group. During fear acquisition, moving the joystick in 2 directions (conditioned stimulus [CS+]) was followed by a painful electrocutaneous stimulus (pain-unconditioned stimulus [US]), whereas moving the joystick in 2 other directions was not (CS). During fear reduction, 1 CS+ was extinguished, but another CS+ was still followed by pain in the extinction group; in the counterconditioning group, 1 CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). The results indicate that counterconditioning effectively reduces pain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement attenuated neither fear nor the intensity/unpleasantness of the pain. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse. Perspective: This article reports no immediate differences between counterconditioning and extinction in reducing pain-related fear in the laboratory. Unexpectedly, both methods also altered stimulus valence. However, we cautiously suggest that methods explicitly focusing on altering the affective valence of feared movements may improve the long-term effectiveness of fear reduction and prevent relapse. (C) 2015 by the American Pain Society
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