When experience is not enough: learning-based cognitive pain modulation with or without instructions. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Zaman, Jonas; Vlaeyen, Johan W.S.; Wiech, Katja
• Is Part Of: Pain. Volume 163:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: Pain -- Expectations -- Decision-making -- Instructions -- Learning; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000002322
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: The effects of expectations on pain perception are often studied using large differences in pain probabilities between experimental conditions, although they may be far more subtle in clinical contexts and, therefore, more difficult to detect. The current study aimed to investigate at which point subtle differences in pain probabilities can be detected and lead to differentiable expectations and perceptions. Furthermore, we investigated whether instructions can aid learning from experience and enhance subsequent pain modulatory effects. During a predictive learning task, participants were presented with 5 different cues, followed by either a high and low noxious stimulus. They learned about the different cue-stimulus contingencies either solely through experience (LEARN, N = 40) or a combination of experience and explicit information about the cue-stimulus contingencies (INSTRUCT, N = 40). We found that without explicit information, picking up the different pain probabilities was challenging, while explicit instruction significantly improved their detection. As revealed by drift diffusion modeling, learning from experience was insufficient for the development of a bias towards low pain even when it was highly likely. By contrast, when explicit information was provided, perception became more nuanced with the direction and extent of bias, capturing the subtle differences in pain probabilities. These findings highlight that the use of instructions to foster the detection of subtle pain improvements during pain treatment to enhance their cognitive pain modulatory effects warrant further investigation. Abstract : Supplemental Digital Content is Available in the Text.Detection of subtle differences in pain probabilities was challenging based solely on experience-learning and can lead to a narrow range of expectations and perceived intensity of pain. Explicit information fostered detection of condition differences, and these differential expectations translated into a more nuanced perception of pain.