Underpredicting pain: an experimental investigation into the benefits and risks

Abstract

Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (ie, assimilation effects), as seen with placebo effects. However, in case of large expectation–experience discrepancies, experiences might change away from what is expected (ie, contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. In addition, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (study 1: n = 81 and study 2: n = 123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; study 2 only), or nonpainful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (ie, assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction vs medium underprediction generally did not differ. Moreover, study 2 provided some indications for reduced heart rate and skin conductance levels but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (ie, cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.

Association of affective state with the assimilation of daily pain expectancy and pain experience

“…However, there have also been numerous reports of null associations between both state and trait affects and placebo or nocebo effects, most of which have come from controlled experimental studies in healthy participants. 19,35 The inconsistency of the laboratory data, and the relative paucity of studies in clinical samples, has made it difficult to appraise the ecological relevance of affect in the arc from clinical pain expectancy to clinical pain experience.…”

Beyond Pain Scales: A Critical Phenomenology of the Expression of Pain

“…When experiencing pain, people are sometimes able to imaginatively shape their conception of their painful feelings to cope better with their impact ( 41 – 43 ). In this context, we argue that imagination should be conceived as a cognitive and affective strategy for transforming lived reality and making sense of personal experience.…”

Counterconditioning as Treatment to Reduce Nocebo Effects in Persistent Physical Symptoms: Treatment Protocol and Study Design

“…While deception is generally considered acceptable for research, it is problematic to use deception in clinical care, as patients should always be fully informed regarding the treatment they are about to receive ( Riddick, 2003 ). Deception could harm the trust in both the healthcare professional and the treatment ( Miller et al, 2005 ; Peerdeman et al, 2021 ), which could lead to reduced treatment efficacy and treatment adherence. Open-label placebos have been examined in several studies (in both healthy and clinical populations) and have been found to be an effective treatment ( Sandler and Bodfish, 2008 ; Kaptchuk et al, 2010 ; Carvalho et al, 2016 ; Schaefer et al, 2018 ; Kleine-Borgmann et al, 2019 ); in some studies, open-label placebos were even as effective as closed-label placebo treatments ( Locher et al, 2017 ; Lembo et al, 2021 ).…”