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Perceptual Inference in Chronic Pain: An Investigation Into the Economy of Action Hypothesis

Tabor, Abby PhD; O’Daly, Owen PhD; Gregory, Robert W. MBBS; Jacobs, Clair MSc; Travers, Warren MSc; Thacker, Michael A. PhD; Moseley, Graham Lorimer PhD

The Clinical Journal of Pain: July 2016 - Volume 32 - Issue 7 - p 588–593
doi: 10.1097/AJP.0000000000000305
Original Articles

Objective: The experience of chronic pain critically alters one’s ability to interact with their environment. One fundamental issue that has received little attention, however, is whether chronic pain disrupts how one perceives their environment in the first place. The Economy of Action hypothesis purports that the environment is spatially scaled according to the ability of the observer. Under this hypothesis it has been proposed that the perception of the world is different between those with and without chronic pain. Such a possibility has profound implications for the investigation and treatment of pain. The present investigation tested the application of this hypothesis to a heterogenous chronic pain population.

Methods: Individuals with chronic pain (36; 27F) and matched pain-free controls were recruited. Each participant was required to judge the distance to a series of target cones, to which they were to subsequently walk. In addition, at each distance, participants used Numerical Rating Scales to indicate their perceived effort and perceived pain associated with the distance presented.

Results: Our findings do not support the Economy of Action hypothesis: there were no significant differences in distance estimates between the chronic pain and pain-free groups (F 1,60=0.927; P=0.340). In addition, we found no predictive relationship in the chronic pain group between anticipated pain and estimated distance (F 1,154=0.122, P=0.727), nor anticipated effort (1.171, P=0.281) and estimated distance (F 1,154=1.171, P=0.281).

Discussion: The application of the Economy of Action hypothesis and the notion of spatial perceptual scaling as a means to assess and treat the experience of chronic pain are not supported by the results of this study.

*Sansom Institute for Health Research, University of South Australia, Adelaide, SA

Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia

School of Biomedical Sciences, Centre of Human and Aerospace Physiological Sciences and Pain Research Section, Neuroimaging, Institute of Psychiatry, King’s College London

§INPUT Pain Management

Physiotherapy Department, Guy’s and St Thomas’ NHS Foundation Trust, London

East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, Surrey, UK

A.T.: primary author, development of idea, manuscript preparation, data collection, analysis, and interpretation. O.O.’D.: development of idea, data analysis, and manuscript editing. R.W.G.: participant recruitment, data analysis, and manuscript editing. C.J. and W.T.: participant recruitment and manuscript editing. M.A.T.: development of idea, data analysis, and manuscript editing. G.L.M.: initial concept, development of idea, data analysis and interpretation, and manuscript editing.

A.T. is supported by the University of South Australia President’s Scholarship; G.L.M. is supported by a NHMRC research fellowship (ID 1061279). The authors declare no conflict of interest.

Reprints: Abby Tabor, PhD, Sansom Institute for Health Research, University of South Australia, G.P.O. Box 2473, Adelaide, SA 5001, Australia (e-mail:

Received April 21, 2015

Received in revised form October 16, 2015

Accepted September 15, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.