Overgeneralization of Pain-Related Fear and Avoidance

Accumulating evidence shows that pain-related fear is often more disabling than the pain itself, and contributes to the transition from acute to chronic pain disability. Growing evidence suggests that pain-related fear is acquired via associative learning. In the clinic, however, spreading of fear and avoidance is observed beyond movements/activities that were associated with pain during the original pain episode. From an associative learning perspective, one mechanism accounting for this spreading of fear is stimulus generalization. We propose that overgeneralization may play a role in the etiology and/or maintenance of chronic pain disability by spreading of undesired defensive behaviors. In this talk, I will present a series of experiments showing (1) differences in generalization of pain-related fear and pain-expectancy between chronic pain patients (chronic hand pain patients and fibromyalgia patients) and healthy pain-free controls, (2) that these protective responses persist despite corrective feedback in patients but not in healthy controls (reduced extinction), (3) that patients also demonstrate selective learning deficits in different conditioning paradigms (e.g. blocking procedure), and (4) that overgeneralization of instrumentally acquired pain-related avoidance behavior also exists in people with high levels of trait anxiety and chronic pain.