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Testing a positive affect induction to reduce verbally induced nocebo hyperalgesia in an experimental pain paradigm

Geers, Andrew L.1; Close, Shane1; Caplandies, Fawn C.1; Vogel, Charles L.1; Murray, Ashley B.1; Pertiwi, Yopina1; Handley, Ian M.2; Vase, Lene3

doi: 10.1097/j.pain.0000000000001618
Research Paper: PDF Only

There is an ethical obligation to notify individuals about potential pain associated with diagnoses, treatments, and procedures; however, supplying this information risks inducing nocebo hyperalgesia. Currently there are few empirically-derived strategies for reducing nocebo hyperalgesia. Since nocebo effects are linked to negative affectivity, we tested the hypothesis that a positive affect induction can disrupt nocebo hyperalgesia from verbal suggestion. Healthy volunteers (N =147) were randomly assigned to conditions in a 2 (Affect Induction: Positive vs. Neutral) by 2 (Verbal Suggestion: No Suggestion vs. Suggestion of Pain Increase) between-subjects design. Participants were induced to experience positive or neutral affect by watching movie clips for 15 mins. Next, participants had an inert cream applied to their non-dominant hand and suggestion was manipulated by telling only half the participants the cream could increase the pain of the upcoming cold pressor test. Subsequently, all participants underwent the cold pressor test (8°C ±.04°C), wherein they submerged the non-dominant hand and rated pain intensity on numerical rating scales every 20 sec up to two mins. In the neutral affect conditions, there was evidence for the nocebo hyperalgesia effect: participants given the suggestion of pain displayed greater pain than participants not receiving this suggestion, ps<.05. Demonstrating a blockage effect, nocebo hyperalgesia did not occur in the positive affect conditions, ps>.5. This is the first study to show that positive affect may disrupt nocebo hyperalgesia thereby pointing to a novel strategy for decreasing nocebo effects without compromising the communication of medical information to patients in clinical settings.

1University of Toledo

2Montana State University

3Aarhus University

Corresponding Author: Andrew L. Geers, Ph.D. Professor of Psychology Department of Psychology University of Toledo Toledo, OH 43606 Phone: 419-530-8530 Fax: 419-530-8479 Email:

© 2019 International Association for the Study of Pain
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