Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis

Victoria J Madden, Daniel S Harvie, Romy Parker, Karin B Jensen, Johan W S Vlaeyen, G Lorimer Moseley, Tasha R Stanton

Research output: Contribution to journalReview articleResearchpeer-review

22 Citations (Scopus)

Abstract

Background. Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent amplification of pain, or evocation of pain in the absence of nociception. Methods. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or amplify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Results. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia; one did not. Pooled effects (n58 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95%CI: 4.00–10.80] on a 0–100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. Conclusion. The existing literature suggests that classical conditioning can amplify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.

Original languageEnglish
Pages (from-to)1094-1111
Number of pages18
JournalPain Medicine
Volume17
Issue number6
DOIs
Publication statusPublished - 1 Jun 2016
Externally publishedYes

Fingerprint

Hyperalgesia
Meta-Analysis
Pain
Classical Conditioning
Library Science
Learning
Problem-Based Learning
Nociception
PubMed

Cite this

Madden, V. J., Harvie, D. S., Parker, R., Jensen, K. B., Vlaeyen, J. W. S., Moseley, G. L., & Stanton, T. R. (2016). Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis. Pain Medicine, 17(6), 1094-1111. https://doi.org/10.1093/pm/pnv044
Madden, Victoria J ; Harvie, Daniel S ; Parker, Romy ; Jensen, Karin B ; Vlaeyen, Johan W S ; Moseley, G Lorimer ; Stanton, Tasha R. / Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis. In: Pain Medicine. 2016 ; Vol. 17, No. 6. pp. 1094-1111.
@article{19ca3c0b181b4f5395392c9107f5132a,
title = "Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans?: A Systematic Review and Meta-Analysis",
abstract = "Background. Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent amplification of pain, or evocation of pain in the absence of nociception. Methods. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or amplify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Results. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia; one did not. Pooled effects (n58 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95{\%}CI: 4.00–10.80] on a 0–100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. Conclusion. The existing literature suggests that classical conditioning can amplify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.",
author = "Madden, {Victoria J} and Harvie, {Daniel S} and Romy Parker and Jensen, {Karin B} and Vlaeyen, {Johan W S} and Moseley, {G Lorimer} and Stanton, {Tasha R}",
note = "{\circledC} 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.",
year = "2016",
month = "6",
day = "1",
doi = "10.1093/pm/pnv044",
language = "English",
volume = "17",
pages = "1094--1111",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "VICER Publishing",
number = "6",

}

Madden, VJ, Harvie, DS, Parker, R, Jensen, KB, Vlaeyen, JWS, Moseley, GL & Stanton, TR 2016, 'Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis' Pain Medicine, vol. 17, no. 6, pp. 1094-1111. https://doi.org/10.1093/pm/pnv044

Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis. / Madden, Victoria J; Harvie, Daniel S; Parker, Romy; Jensen, Karin B; Vlaeyen, Johan W S; Moseley, G Lorimer; Stanton, Tasha R.

In: Pain Medicine, Vol. 17, No. 6, 01.06.2016, p. 1094-1111.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans?

T2 - A Systematic Review and Meta-Analysis

AU - Madden, Victoria J

AU - Harvie, Daniel S

AU - Parker, Romy

AU - Jensen, Karin B

AU - Vlaeyen, Johan W S

AU - Moseley, G Lorimer

AU - Stanton, Tasha R

N1 - © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background. Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent amplification of pain, or evocation of pain in the absence of nociception. Methods. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or amplify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Results. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia; one did not. Pooled effects (n58 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95%CI: 4.00–10.80] on a 0–100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. Conclusion. The existing literature suggests that classical conditioning can amplify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.

AB - Background. Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent amplification of pain, or evocation of pain in the absence of nociception. Methods. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or amplify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Results. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia; one did not. Pooled effects (n58 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95%CI: 4.00–10.80] on a 0–100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. Conclusion. The existing literature suggests that classical conditioning can amplify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.

UR - http://www.scopus.com/inward/record.url?scp=85010908331&partnerID=8YFLogxK

U2 - 10.1093/pm/pnv044

DO - 10.1093/pm/pnv044

M3 - Review article

VL - 17

SP - 1094

EP - 1111

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 6

ER -

Madden VJ, Harvie DS, Parker R, Jensen KB, Vlaeyen JWS, Moseley GL et al. Can Pain or Hyperalgesia Be a Classically Conditioned Response in Humans? A Systematic Review and Meta-Analysis. Pain Medicine. 2016 Jun 1;17(6):1094-1111. https://doi.org/10.1093/pm/pnv044