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Pain-avoidance versus reward-seeking

an experimental investigation

Claes, Nathalie; Crombez, Geert; Vlaeyen, Johan W. S.

doi: 10.1097/j.pain.0000000000000116
Research Paper

According to fear-avoidance models, a catastrophic interpretation of a painful experience may give rise to pain-related fear and avoidance, leading to the development and maintenance of chronic pain problems in the long term. However, little is known about how exactly motivation and goal prioritization play a role in the development of pain-related fear. This study investigates these processes in healthy volunteers using an experimental context with multiple, competing goals. In a differential human fear-conditioning paradigm, 57 participants performed joystick movements. In the control condition, one movement (conditioned stimulus; CS+) was followed by a painful electrocutaneous unconditioned stimulus (pain-US) in 50% of the trials, whereas another movement (nonreinforced conditioned stimulus; CS) was not. In the experimental condition, a reward in the form of lottery tickets (reward-US) accompanied the presentation of the pain-US. Participants were classified into 3 groups, as a function of the goal, they reported to be the most important: (1) pain-avoidance, (2) reward-seeking, and (3) both goals being equally important. Results indicated that neither the reward co-occurring with pain nor the prioritized goal modulated pain-related fear. However, during subsequent choice trials, participants selected the painful movement more often when the reward was presented compared with the context in which the reward was absent. The latter effect was dependent on goal prioritization, with more frequent selections in the reward-seeking group, and the least selections in the pain-avoidance group. Taken together, these results underscore the importance of competing goals and goal prioritization in the attenuation of avoidance behavior.

A concurrent reward diminishes pain-avoidance in healthy subjects, especially in those who prioritize earning the reward over avoiding pain.

aResearch Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium

bDepartment of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium

cDepartment of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands

dCenter for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium

Corresponding author. Address: Department of Psychology, University of Leuven, Tiensestraat 102, Box 3726, 3000 Leuven, Belgium. Tel.: +32 (0)16 32 58 85; fax: +32 (0)16 32 61 44. E-mail address: (N. Claes).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received December 11, 2014

Received in revised form January 13, 2015

Accepted January 27, 2015

© 2015 International Association for the Study of Pain
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