Uncertainty in a context of pain: disliked but also more painful?

Zaman, Jonas; Oudenhove, Lukas Van; Vlaeyen, Johan W. S.

doi:10.1097/j.pain.0000000000002106

Cited by 18 publications

(41 citation statements)

References 41 publications

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“…These findings echoed a preceding study which observed similar results but with marginal significance (Lorenz et al, 2005). Interestingly, Brown et al (2008) already interpreted their results through an embryonic formulation of predictive processing (at the time), suggesting as a recent review (Zaman et al, 2021) that when faced with uncertainty concerning upcoming stimulation, participants were biased towards their mean prior expectation and not forcefully towards hypo-or hyperalgesia. Our paradigm allowed us to test once more this prediction on both intensity and unpleasantness pain ratings.…”

Section: Introductionsupporting

confidence: 78%

“…Our modeling analysis revealed an effect of cue uncertainty on pain ratings, which increased the variance of the cue-dependent prior (𝜂 > 0), thereby globally reducing the influence of cue-based expectations on pain perception as suggested by a recent review (Zaman et al, 2021). However, our computational implementation did not specifically model the interaction between the mean and precision (inverse variance) of the cue.…”

Section: Effects Of Expectations and Uncertainty On Pain Ratingsmentioning

confidence: 82%

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Modulation of the sensory and affective dimensions of pain by expectations and uncertainty: a Bayesian modeling approach

Poublan-couzardot¹,

Pagnoni²,

Lutz³

2022

Preprint

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The perception of pain is sensitive to various mental processes such as expectation about the nociceptive stimulus or individual differences in the affective and cognitive evaluations of pain. A promising candidate to study the neurocomputational principles of pain perception is the theory of predictive processing which offers a general framework to understand perception and cognition. Rethinking the brain as a Bayesian inference organ, this theory has been recently applied to the experience of pain and its modulation with convincing results. We adapted an existing pain cueing paradigm to collect pain intensity and unpleasantness ratings on fifty-four healthy subjects with ongoing meditation experience, while manipulating expectations and uncertainty about impending electrical stimulations. Using state-of-the-art statistical modeling, we modeled the generation of trial-wise pain ratings as a Bayesian inference process integrating probability distributions over sensory information, cue-based expectations and a trait-like, individual prior about pain experience. Notably, we extended previous hierarchical Bayesian models of pain by successfully accounting for both the sensory and the affective components of pain. As predicted, psychological measures of pain catastrophizing and cognitive defusion showed opposite correlation patterns with their computational counterparts. Additionally, the lifetime meditation practice of our participants was strongly and inversely correlated with the weight of short-term expectations in the perceptual process, as well as with a trait-like prior influencing the affective dimension of pain. We conclude that this approach offers a promising avenue for future studies on meditation-induced plasticity of pain perception.

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Section: Introductionsupporting

confidence: 78%

Section: Effects Of Expectations and Uncertainty On Pain Ratingsmentioning

confidence: 82%

Modulation of the sensory and affective dimensions of pain by expectations and uncertainty: a Bayesian modeling approach

Poublan-couzardot¹,

Pagnoni²,

Lutz³

2022

Preprint

View full text Add to dashboard Cite

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“…Trauma is unpredictable, and this unpredictability has received increasing attention in the context of pain perception. 26 Likewise, the posttraumatic preoperative phase appears to be essential in the development of CPSP. First, the CPSP patients at Y1 reported more intense pain at rest-after trauma and early on after surgery.…”

Section: Discussionmentioning

confidence: 99%

Chronic Pain Following Fracture-Related Surgery: Posttraumatic Rather Than Postsurgical Origin Promotes Chronification—A Prospective Observational Study With 1-Year Follow-up

Aulenkamp

Malewicz

Brauckhoff

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Chronic posttraumatic/postsurgical pain (CPSP) is common after traumatic or surgical damage. Exposure to both trauma and surgery, with the potential for repeated bone and nerve damage, may increase the risk of CPSP after fracture-related surgery. But the (long-term) incidences of CPSP and neuropathic CPSP and the ensuing burdens are unknown. Therefore, the patients were prospectively assessed within 1 year, and the patient-specific characteristics were explored. METHODS: Between 2017 and 2018, 127 patients (age: 52.9 ± 17.1 years, male: 55.1%) with traumatic fractures needing osteosynthesis (extremities: 91.3%) were assessed posttrauma (before surgery), postsurgery at days 1 to 5, 6 weeks, 3 and 12 months. The primary outcomes are as follows: incidence at 3 and 12 months of CPSP (defined as pain intensity on a numerical rating scale [NRS: 0–10] ≥3), secondary exploration: neuropathic CPSP (NRS ≥3 and Douleur Neuropathique 4 interview [DN4i] score ≥3 [Douleur Neuropathique interview: 0–7]); burden: quality of life (QoL, the EuroQOL five dimensions questionnaire [EQ-5D-3L] descriptive system); and inter alia, the number of analgesics (trial registration: DRKS00011601). RESULTS: The incidence of CPSP was 57.1% (52/91, n/N) at 3 and 42.7% (35/82) at 12 months postsurgery, including neuropathic CPSP 7.7% (4/52) and 17.1% (6/35), respectively. Descriptively, posttraumatic higher pain intensity at rest (difference of 0.9 ± 1.8 NRS) and the need for more frequent analgesics (by 34.3%) were associated with CPSP a year after surgery compared to those without. As soon as week 6, these patients had developed descriptively a 15% more impaired QoL, with 25% more impairment after 1 year. The patients with CPSP presented with at least 1 neuropathic symptom 12 months later in 68.6% (24/35) of cases, mainly with an early posttraumatic occurrence (without fulfilling the definition of neuropathic CPSP). CONCLUSIONS: After early fracture-related surgery, high incidences of CPSP (43%) were prospectively observed 1 year postsurgery, up to approximately 1 in 5 patients who had neuropathic CPSP. At the same time, CPSP was accompanied with an impacted QoL and analgesic dependence, both indicating clinical relevance. Moreover, the high incidence and the early posttraumatic occurrence of more intense pain suggest that the initial fracture-related trauma, rather than the surgical trauma, may predominantly trigger CPSP at Y1 (1 year). Therefore, these exploratory results set the direction of required future research. A future clinical hypothesis might be: treat first what hurts first.

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“…Uncertainty is said to occur when one is not able to accurately evaluate events or predict outcomes (Mishel, 1988). It is inherently aversive (Carleton, 2016;Zaman et al, 2021), and central to anxiety pathology . Anxiety has been defined as "anticipatory affective, cognitive, and behavioral changes in response to uncertainty about potential future threat" , p. 2).…”

Section: Uncertainty Expectations and Their Effect On Exploration And Avoidance Generalizationmentioning

confidence: 99%

“…In the lives of people with chronic pain, uncertainty can occur on many different levels (McCormick, 2002;Zaman et al, 2021), such as not knowing the cause, meaning, and/or best course of action relating to their pain. It is not hard to see how pain, perceived as uncertain and uncontrollable, may motivate someone to control excessively, i.e.…”

Section: Uncertainty Expectations and Their Effect On Exploration And Avoidance Generalizationmentioning

confidence: 99%

You’ll never know if you never try

Glogan¹

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Avoidance is considered a key contributor to the development and maintenance of chronic pain disability, likely through its excessive generalization. This study investigated whether acquired avoidance behavior generalizes to novel but similar movements. Using a robotic arm, participants moved their arm from a starting to a target location via one of three possible movement trajectories. For the Experimental Group, the shortest, easiest trajectory was always paired with pain (T1 = 100% reinforcement/no resistance and deviation). Pain could be partly or completely avoided by choosing increasingly effortful movements (T2 = 50% reinforcement, moderate resistance/deviation; T3 = 0% reinforcement, strongest resistance/largest deviation). A Yoked Group received the same number of painful stimuli irrespective of their own behavior. Outcomes were self-reported fear of movement-related pain, pain-expectancy, avoidance behavior, (maximal deviation from the shortest trajectory), and trajectory choice behavior. We tested generalization to three novel, unreinforced trajectories (G1-3) positioned next to the acquisition trajectories. Whereas acquired fear of movement-related pain and pain-expectancy generalized in the Experimental Group, avoidance behavior did not, suggesting that threat beliefs and high-cost avoidance may not be directly related. The lack of avoidance generalization may be due to a perceived context-switch in the configurations of the acquisition and the generalization phases.

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Uncertainty in a context of pain: disliked but also more painful?

Cited by 18 publications

References 41 publications

Modulation of the sensory and affective dimensions of pain by expectations and uncertainty: a Bayesian modeling approach

Modulation of the sensory and affective dimensions of pain by expectations and uncertainty: a Bayesian modeling approach

Chronic Pain Following Fracture-Related Surgery: Posttraumatic Rather Than Postsurgical Origin Promotes Chronification—A Prospective Observational Study With 1-Year Follow-up

You’ll never know if you never try

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