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Anticipatory effects on perceived pain: Associations with development and anxiety

Michalska, Kalina J., Ph.D.1; Feldman, Julia S., B.A.2; Abend, Rany, Ph.D.3; Gold, Andrea L., Ph.D.3; Dildine, Troy C., B.A.4,5; Palacios-Barrios, Esther E., B.A.2; Leibenluft, Ellen, MD3; Towbin, Kenneth E., MD3; Pine, Daniel S., MD3; Atlas, Lauren Y., Ph.D.4,6

doi: 10.1097/PSY.0000000000000608
Invited Article: PDF Only

Objective Naturalistic studies suggest that expectation of adverse experiences such as pain exerts particularly strong effects on anxious youth. In healthy adults, expectation influences the experience of pain. The current study uses experimental methods to compare the effects of expectation on pain among adults, healthy youth, and youth with an anxiety disorder.

Methods Twenty-three healthy adults, 20 healthy youth, and 20 youth with an anxiety disorder underwent procedures in which auditory cues were paired with noxious thermal stimulation. Through instructed conditioning, one cue predicted low pain stimulation and the other predicted high pain stimulation. At test, each cue was additionally followed by a single temperature calibrated to elicit medium pain ratings. We compared cue-based expectancy effects on pain across the three groups, based on cue effects on pain elicited on medium heat trials.

Results Across all groups, as expected, participants reported greater pain with increasing heat intensity (β = 2.29, t(41) = 29.94, p < .001). Across all groups, the critical medium temperature trials were rated as more painful in the high- relative to low-expectancy condition (β = 1.72, t(41) = 10.48, p < .001). However, no evidence of between-group differences or continuous associations with age or anxiety were observed.

Conclusions All participants showed strong effects of expectancy on pain. No influences of development or anxiety arose. Complex factors may influence associations among anxiety, development, and pain reports in naturalistic studies. Such factors may be identified using experiments that employ more complex, yet controlled manipulations of expectancy or assess neural correlates of expectancy.

1University of California Riverside, Department of Psychology, Riverside, CA, USA

2University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA

3The National Institute of Mental Health, Emotion and Development Branch, Bethesda, MD, USA

4National Center for Complementary and Integrative Health, Bethesda, MD, USA

5Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

6National Institute on Drug Abuse, Baltimore, MD, USA

Conflict of Interest: The authors declare no conflict of interest related to this work.

Supported by National Institute of Mental Health Intramural Research Program Project number ZIAMH00278 and National Center for Complementary and Integrative Health Project number ZIAAT000032.

Copyright © 2018 by American Psychosomatic Society
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