Fear‐learning deficits in subjects with fibromyalgia syndrome?

Jenewein, Josef; Moergeli, Hanspeter; Sprott, Haiko; Honegger, D; Brunner, L; Ettlin, Dominik A; Grillon, Christian; Bloch, K E; Brügger, Mike; Schwegler, Kyrill; Schumacher, Sonja; Hasler, Gregor

doi:10.1002/j.1532-2149.2013.00300.x

Cited by 34 publications

(44 citation statements)

References 48 publications

(57 reference statements)

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“…This corroborates earlier findings by Meulders et al [24; 25] demonstrating in a voluntary joystick movement paradigm, in which one movement (CS+) was consistently followed by a noxious electrocutaneous stimulus and another movement (CS-) was not, that FM patients acquired differential fear of movement-related pain to the same extent as the HC group, albeit slower. These findings however contradict those of Jenewein et al [15] showing learning deficits in FM patients compared to patients with osteoarthritis and HC in a differential fear conditioning paradigm using geometrical figures as CSs and a painful heat stimulus as US.…”

Section: Discussioncontrasting

confidence: 99%

Reduced selective learning in patients with fibromyalgia vs healthy controls

Meulders

Boddez

Blanco

et al. 2018

Pain

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Impaired selective fear learning has been advanced as a core mechanism involved in excessive spreading of protective responses such as pain-related fear and avoidance leading to disability in chronic pain conditions. Using the litmus test for selective learning effects, the blocking procedure, we tested the hypothesis that patients with fibromyalgia (FM) show less selective threat learning than healthy controls (HCs). We introduce a novel selective learning task based around a clinical diary scenario. On a trial-by-trial basis, participants rated whether they expected certain situations (A, B, Z, and X) in the diary of a fictive FM patient would trigger pain in that patient. The procedure did not involve any experimental pain induction because the verbal outcomes "pain" or "no pain" were used. During the elemental acquisition phase, one situation was followed by "pain" (A+, eg, "Kim slept badly, and reports pain"), whereas another situation was followed by "no pain" (Z-, eg, "Kim was stressed, and reports no pain"). During the compound acquisition phase, another situation (X), referred to as the blocked stimulus, was presented in compound with a previously pain-eliciting situation and also paired with "pain" (AX+, eg, Kim slept badly" and "Kim has vacuumed," and reports pain). Simultaneously, a novel situation was introduced and also followed by "pain" (B+). Within-group comparisons showed blocking (ie, significant difference between B and X) in the HCs, but not in the patients with FM. This study is the first in directly assessing differences in selective learning between patients with FM and HCs using a blocking procedure.

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Section: Discussioncontrasting

confidence: 99%

Reduced selective learning in patients with fibromyalgia vs healthy controls

Meulders

Boddez

Blanco

et al. 2018

Pain

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“…These results contradict the findings of Jenewein et al, 32 demonstrating that only 50% of the patients with FM were contingency aware as compared with 100% and 86% of the HC and the osteoarthritis group, respectively. This finding might be associated with the less clear-cut contingencies in their study.…”

Section: Discussioncontrasting

confidence: 97%

Differences in pain-related fear acquisition and generalization

Meulders¹,

Jans²

2015

Pain

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Anomalies in fear learning, such as failure to inhibit fear to safe stimuli, lead to sustained anxiety, which in turn may augment pain. In the same vein, stimulus generalization is adaptive as it enables individuals to extrapolate the predictive value of 1 stimulus to similar stimuli. However, when fear spreads in an unbridled way to novel technically safe stimuli, stimulus generalization becomes maladaptive and may lead to dysfunctional avoidance behaviors and culminate in severe pain disability. In a voluntary movement conditioning paradigm, we compared the acquisition and generalization of pain-related fear in patients with fibromyalgia (FM) and healthy controls. During acquisition, participants received predictable pain in 1 context (ie, 1 movement predicts pain, whereas another does not), and unpredictable pain in another (ie, pain never contingent upon movement). Fear generalization to novel movements (resembling the original painful or nonpainful movement) was tested in both contexts. Results indicated that the FM group showed slower differential acquisition of pain-related fear in the predictable context, and more contextual pain-related fear in the unpredictable context. Fear of movement-related pain spreads selectively to novel movements similar to the original painful movement, and not to those resembling the nonpainful movement in the healthy controls, but nondifferential fear generalization was observed in FM. As expected, in the unpredictable context, we also observed nondifferential fear generalization; this effect was more pronounced in FM. Given the status of overgeneralization as a plausible transdiagnostic pathogenic marker, we believe that this research might increase our knowledge about pathogenesis of musculoskeletal widespread pain.

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“…Using the same experiment in our own previous study, we showed potentially pathogenic associations between fear and pain in individuals with fibromyalgia. 13 Because of the strong association between PTSD and pain, this experiment, which used a painful US that allowed us to assess pain perception, seemed to qualify for the investigation of the pathophysiology of PTSD.…”

Section: Discussionmentioning

confidence: 99%

“…13 Before the experiment, study participants were instructed that they would see shapes on a screen in front of them and feel heat bursts on their hand, but we did not provide any information about the relationship between these 2 stimuli. Thermal stimulation and the recording of physiological activity (skin conductance) were controlled using a BIOPAC MP150 System (Biopac Systems, Inc, Goleta, CA).…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study, we examined associations between anxiety and pain in subjects with either fibromyalgia syndrome or rheumatoid arthritis, versus that in control subjects, 13 using a fear conditioning experiment that involved an alternatively painful or nonpainful US, and visual conditioned stimuli flashed on a screen in front of the patient immediately before the US. In our experiment, in healthy control subjects and rheumatoid arthritis subjects, a visual stimulus sometimes followed by pain (CS+) induced more fear than one never followed by pain (CS−); in addition, pain ratings were higher after CS+ than after CS−, suggesting that fear itself increased pain perception.…”

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confidence: 99%

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Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

Jenewein

Erni

Moergeli

et al. 2016

The Journal of Pain

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There is growing evidence that fear learning abnormalities are involved in the development of posttraumatic stress disorder (PTSD) and chronic pain. More than 50% of PTSD patients suffer from chronic pain. This study aimed to examine the role of fear-learning deficits in the link between pain perception and PTSD. We included 19 subjects with PTSD and 21 age- and sex-matched healthy control subjects in a fear-conditioning experiment. The conditioned stimulus (CS) consisted of visual signs flashed upon a screen in front of each subject. The unconditioned stimulus was either a low or high temperature impulse delivered through a thermal contact thermode on the subjects’ hand. A designation of ‘CS−’ was assigned to CS always followed by nonpainful low-temperature stimuli; a designation of ‘CS+’ was given to CS that were randomly followed by either a low or a more painful high temperature. Skin conductance was used as a physiological marker of fear. In healthy control subjects, CS+ induced more fear than CS−, and a low-temperature stimulus induced less subjective pain after CS− than after CS+. PTSD subjects failed to demonstrate such adaptive conditioning. Fear ratings after CS presentation were significantly higher in the PTSD group than in the control group. There were significant interaction effects between group and the type of CS on fear and pain ratings. Fear-learning deficits are a potentially promising, specific psychopathological factor in altered pain perception associated with PTSD. Deficits in safety learning may increase fear and, consequently, pain sensations. These findings may contribute to elucidating the pathogenesis behind the highly prevalent comorbidity that exists between PTSD and pain disorders, and to developing new treatments.

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Fear‐learning deficits in subjects with fibromyalgia syndrome?

Cited by 34 publications

References 48 publications

Reduced selective learning in patients with fibromyalgia vs healthy controls

Reduced selective learning in patients with fibromyalgia vs healthy controls

Differences in pain-related fear acquisition and generalization

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder

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