Mechanisms of Pain-Related Decision-Making, Prediction Errors, and Learning in Acute and Chronic Pain

Daily life requires constant decision-making, with some decisions having strong effects on quality of life and well-being. Cognitive capabilities, including cognitive flexibility, as basic elements needed for decision-making are impaired in patients with chronic pain. Such impaired decision-making can also result in impaired learning. In addition to effects of long-term pain on cognition, cognition can strongly modulate how pain is perceived, indicating bidirectional and reciprocal effects. Despite this knowledge, the mechanisms underlying the interaction decision-making and related learning and pain remain largely unknown. Dr. Becker will present results on the role of the neurotransmitter dopamine in prediction errors during pain-related decision making and the association of such prediction errors with reward-induced pain inhibition based on computational reinforcement learning models. She will present novel data  on alterations in pain-related decision-making in patients with fibromyalgia and chronic back pain. In particular, she will discuss findings of altered learning related to prediction-errors in chronic pain, and how these can be captured by computational models. She will further discuss the neural underpinnings of these behavioural findings, and their relationship to clinical pain characteristics.