The role of operant conditioning in chronic pain: an experimental investigation

Flor, Herta; Knost, Bärbel; Birbaumer, Niels

doi:10.1016/s0304-3959(01)00385-2

Cited by 163 publications

(124 citation statements)

References 28 publications

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“…The important role of learning processes in the development of chronic pain has been recognized (77) and resulted in the development of successful operant behavioral treatment regimens (S14) for chronic pain patients. Although there is evidence for clinically relevant learning effects in chronic itch (S15), the formation and reprogramming of itch memory has not yet been systematically explored.…”

Section: Psychoemotional Stress Triggers or Enhances Itchmentioning

confidence: 99%

Frontiers in pruritus research: scratching the brain for more effective itch therapy

Paus

Schmelz

Bı́ró

et al. 2006

Journal of Clinical Investigation

329

287

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This Review highlights selected frontiers in pruritus research and focuses on recently attained insights into the neurophysiological, neuroimmunological, and neuroendocrine mechanisms underlying skin-derived itch (pruritogenic pruritus), which may affect future antipruritic strategies. Special attention is paid to newly identified itch-specific neuronal pathways in the spinothalamic tract that are distinct from pain pathways and to CNS regions that process peripheral pruritogenic stimuli. In addition, the relation between itch and pain is discussed, with emphasis on how the intimate contacts between these closely related yet distinct sensory phenomena may be exploited therapeutically. Furthermore, newly identified or unduly neglected intracutaneous itch mediators (e.g., endovanilloids, proteases, cannabinoids, opioids, neurotrophins, and cytokines) and relevant receptors (e.g., vanilloid receptor channels and proteinase-activated, cannabinoid, opioid, cytokine, and new histamine receptors) are discussed. In summarizing promising new avenues for managing itch more effectively, we advocate therapeutic approaches that strive for the combination of peripherally active antiinflammatory agents with drugs that counteract chronic central itch sensitization. The study of pruritus in a nutshellItching (pruritus) is perhaps the most common symptom associated with numerous skin diseases and can be a lead symptom of extracutaneous disease (e.g., malignancy, infection, and metabolic disorders) (1, S1). However, despite approximately a century of pruritus research (2, S2, S3), there is no generally accepted therapy for the treatment of itch, and many mysteries, misconceptions, and controversies still haunt this rather neglected, yet clinically important and scientifically fascinating, niche in the life sciences (3, 4, 5). It is the brain that itches, not the skinPruritus causes the desire to scratch the skin and is experienced as a sensation arising in the skin. However, like all other skin sensations, itch, strictly speaking, is an extracutaneous event - a product of CNS activities. The intense itch we feel after an insect bite, in a patch of atopic eczema, during an episode of food-induced urticaria, or in association with diabetes, uremia, or scabies mite infection (S1) represents a neuronal projection of a centrally formed sensation into defined regions of the integument (localized pruritus) or into large territories of our body surface (generalized pruritus).Interestingly, our individual reception of and emotional response to itch strongly depends on its exact quality: while a tickling sensation usually is experienced as pleasurable, persistent itch is an annoying or even torturous sensation (S4). While one is tempted to interpret this as indicating a distinct molecular and/or structural basis of these different itch qualities, it has proven excruciatingly difficult to identify their molecular, structural, and neurophysiological differences (ref. 1; see below).As pruritus can arise from localized or systemic, peripheral o...

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Section: Psychoemotional Stress Triggers or Enhances Itchmentioning

confidence: 99%

Frontiers in pruritus research: scratching the brain for more effective itch therapy

Paus

Schmelz

Bı́ró

et al. 2006

Journal of Clinical Investigation

329

287

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“…Drawing on literature on operant reinforcement of pain complaints (e.g., Romano et al, 1992;Manimala et al, 2000;Flor et al, 2002;Jollife and Nicholas, 2004), we expected that parental attention to children's discomfort would be associated with significantly more symptom complaints than parent behavior intended to distract. Based on the likelihood that abdominal pain patients had a long parental reinforcement history vis-à-vis abdominal symptoms, we expected the impact of parental attention on children's symptoms to be stronger for pain patients than for well children.…”

Section: Introductionmentioning

confidence: 99%

Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain

Walker

Williams

Smith

et al. 2006

Pain

299

208

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The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain (N = 104) and well children (N = 119), ages 8-16 years. Parents were randomly assigned and trained to interact with their children according to one of three conditions: Attention, Distraction, or No Instruction. Children's symptom complaints and parents' responses were audiotaped and coded. Children completed a self-report measure of gastrointestinal (GI) symptoms before and after interacting with their parents. Parents' and children's perceptions of their interaction were assessed. Compared to the No Instruction condition, symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition. The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children. Findings for self-report GI symptoms were similar to those for audiotaped symptom complaints. Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition. Parents of pain patients rated distraction as having greater potential negative impact on their children than attention. Parents' responses to children's symptom complaints can significantly increase or decrease those complaints. Girls with functional abdominal pain are particularly vulnerable to the symptom-reinforcing effects of parental attention. KeywordsFunctional abdominal pain; Attention; Distraction; Social learning; Parent-child interaction While sympathy with joy intensifies the sum of joy in the world, sympathy with pain does not really diminish the amount of pain.-Oscar Wilde, The Soul of Man under Socialism

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“…Patients diagnosed with FMS also report poor coping ability (2,3) and display overt expressions of pain (i.e., pain behaviors [4,5]), suggesting that psychological processes may contribute to the maintenance of symptoms and disability (6,7).…”

Section: Introductionmentioning

confidence: 99%

Responder criteria for operant and cognitive–behavioral treatment of fibromyalgia syndrome

Thieme¹,

Turk²,

Flor³

2007

Arthritis & Rheumatism

Self Cite

105

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Objective. To predict the effects of cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT) in fibromyalgia syndrome (FMS).Methods. A total of 125 patients who fulfilled the American College of Rheumatology FMS criteria were randomly assigned to CBT (n ‫؍‬ 42), OBT (n ‫؍‬ 43), or attention placebo (AP; n ‫؍‬ 40). The pretreatment to 12-month followup reliability change index was used to determine clinically meaningful changes in pain intensity and physical impairment. Multinominal logistic regression analyses were used to determine the predictors of improvement in pain intensity and physical impairment for the entire sample. Analyses of variance were computed to compare the characteristics of responders and nonresponders in each of the 3 interventions. Results. At the 12-month followup, 53.5%, 45.2%, and 5% of patients in the OBT, CBT, and AP groups, respectively, reported clinically meaningful improvements in pain intensity. Similarly, 58.1%, 38.1%, and 7.5% of patients treated with OBT, CBT, and AP, respectively, reported clinically significant improvements in physical impairment. Prior to treatment, the OBT physical impairment responders displayed significantly more pain behaviors, physical impairment, physician visits, solicitous spouse behaviors, and level of catastrophizing compared with nonresponders. The CBT physical impairment responders, compared with nonresponders, reported higher levels of affective distress, lower coping, less solicitous spouse behavior, and lower pain behaviors. Conclusion. The results of this study suggest that pretreatment patient characteristics are important predictors of treatment response and may serve as a basis for matching treatments to patient characteristics. Prospective outcome studies are needed to confirm whether the tailoring of treatment actually leads to better outcomes for patients with FMS.

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The role of operant conditioning in chronic pain: an experimental investigation

Cited by 163 publications

References 28 publications

Frontiers in pruritus research: scratching the brain for more effective itch therapy

Frontiers in pruritus research: scratching the brain for more effective itch therapy

Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain

Responder criteria for operant and cognitive–behavioral treatment of fibromyalgia syndrome

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