Classical Conditioning Differences Associated With Chronic Pain: A Systematic Review

Daniel S Harvie, G Lorimer Moseley, Susan L Hillier, Ann Meulders

Research output: Contribution to journalReview articleResearchpeer-review

9 Citations (Scopus)

Abstract

Prominent clinical models of chronic pain propose a fundamental role of classical conditioning in the development of pain-related disability. If classical conditioning is key to this process, then people with chronic pain may show a different response to pain-related conditioned stimuli than healthy control subjects. We set out to determine whether this is the case by undertaking a comprehensive and systematic review of the literature. To identify studies comparing classical conditioning between people with chronic pain and healthy control subjects, the databases MEDLINE, PsychINFO, PsychARTICLES, Scopus, and CINAHL were searched using key words and medical subject headings consistent with 'classical conditioning' and 'pain.' Articles were included when: 1) pain-free control and chronic pain groups were included, and 2) a differential classical conditioning design was used. The systematic search revealed 7 studies investigating differences in classical conditioning between people with chronic pain and healthy control participants. The included studies involved a total of 129 people with chronic pain (fibromyalgia syndrome, spinal pain, hand pain, irritable bowel syndrome), and 104 healthy control participants. Outcomes included indices of pain-related conditioning such as unconditioned stimulus (US) expectancy and contingency awareness, self-report and physiological measures of pain-related fear, evaluative judgements of conditioned stimulus pleasantness, and muscular and cortical responses. Because of variability in outcomes, meta-analyses included a maximum of 4 studies. People with chronic pain tended to show reduced differential learning and flatter generalization gradients with respect to US expectancy and fear-potentiated eyeblink startle responses. Some studies showed a propensity for greater muscular responses and perceptions of unpleasantness in response to pain-associated cues, relative to control cues.

PERSPECTIVE: The review revealed preliminary evidence that people with chronic pain may exhibit less differential US expectancy and fear learning. This characteristic may contribute to widespread fear-avoidance behavior. The assumption that altered classical conditioning may be a predisposing or maintaining factor for chronic pain remains to be verified.

Original languageEnglish
Pages (from-to)889-898
Number of pages10
JournalPain Forum
Volume18
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017
Externally publishedYes

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Classical Conditioning
Chronic Pain
Pain
Fear
Healthy Volunteers
Cues
Startle Reflex
Learning
Medical Subject Headings
Avoidance Learning
Fibromyalgia
Irritable Bowel Syndrome
MEDLINE
Self Report
Meta-Analysis
Hand
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Cite this

Harvie, Daniel S ; Moseley, G Lorimer ; Hillier, Susan L ; Meulders, Ann. / Classical Conditioning Differences Associated With Chronic Pain : A Systematic Review. In: Pain Forum. 2017 ; Vol. 18, No. 8. pp. 889-898.
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Classical Conditioning Differences Associated With Chronic Pain : A Systematic Review. / Harvie, Daniel S; Moseley, G Lorimer; Hillier, Susan L; Meulders, Ann.

In: Pain Forum, Vol. 18, No. 8, 01.08.2017, p. 889-898.

Research output: Contribution to journalReview articleResearchpeer-review

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T2 - A Systematic Review

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AU - Moseley, G Lorimer

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AU - Meulders, Ann

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