From Pavlov to Pain Associative Learning and Extinction of Visceral Pain-Related Fear in Health and Patients with Chronic Visceral Pain

The importance of pain-related learning and memory processes in the pathophysiology and treatment of chronic pain is increasingly recognized. This is not only based on growing evidence that learning and extinction are altered in different pain conditions. It is also conceptually driven by the unique biological salience of pain, which may be especially pronounced for visceral pain. Associative learning and extinction, as studied using Pavlovian fear conditioning as a translational model in the neurosciences, represent fundamental adaptive responses aimed at self-protection. Conditioned pain-related fear is an essential component of this response. In patients with chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to hypervigilance and hyperalgesia. However, visceral pain-related extinction processes and their underlying neural circuitry remain uncharted research territory. This talk will address behavioral and neural mechanisms of visceral pain-related extinction learning in healthy volunteers and patients with irritable bowel syndrome. New data suggesting preferential learning for the visceral modality and impaired extinction of maladaptive visceral pain-related fear and safety responses call for an extension of the fear-avoidance model of pain. The idea of “interoceptive conditioning” will be introduced, along with innovative experimental paradigms modelling different aspects of the clinical reality of patients.