An experimental investigation into the mediating role of pain-related fear in boosting nocebo hyperalgesia. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Thomaidou, Mia Athina; Veldhuijzen, Dieuwke Swaantje; Meulders, Ann; Evers, Andrea Walburga Maria
• Is Part Of: Pain. Volume 162:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: Pain -- Nocebo hyperalgesia -- Fear -- Conditioning -- Negative suggestions -- Learning -- Expectations; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000002017
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: Nocebo hyperalgesia refers to increases in perceived pain that putatively result from negative expectations regarding a nocebo stimulus (eg, an inert treatment, compared with no treatment). The precise cognitive-emotional factors contributing to the origins of nocebo effects are poorly understood. We aimed to test the effects of experimentally induced pain-related fear on the acquisition and extinction of nocebo hyperalgesia in healthy participants (N = 72). Acquisition and extinction of nocebo hyperalgesia were compared between a group receiving standard nocebo conditioning (Control group) and 2 groups receiving distinct fear inductions: high intensity of pain stimulations (High-pain group) or a threat manipulation (High-threat group). During nocebo acquisition, the Control and High-threat groups were administered thermal pain stimulations of moderate intensity paired with sham electrical stimulation (nocebo trials), whereas high pain intensity was administered to the High-pain group. During extinction, equivalent pain intensities were administered across all trials. Pain-related fear was measured by eyeblink startle electromyography and self-report. Nocebo hyperalgesia occurred in all groups. Nocebo effects were significantly larger in the High-pain group than those in the Control group. This effect was mediated by self-reported fear, but not by fear-potentiated startle. Groups did not differ in the extinction rate. However, only the High-pain group maintained significant nocebo responses at the end of extinction. Anticipatory pain-related fear induced through a threat manipulation did not amplify nocebo hyperalgesia. These findings suggest that fear of high pain may be a key contributor to the amplification of nocebo hyperalgesia, only when high pain is experienced and not when it is merely anticipated. Abstract : Supplemental Digital Content is Available in the Text.Pain-related fear is shown to mediate the amplification of nocebo hyperalgesia, only when high pain is experienced and not when it is merely anticipated.