Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands.
Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, The Netherlands; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium.
J Pain. 2020 Nov-Dec;21(11-12):1224-1235. doi: 10.1016/j.jpain.2020.02.003. Epub 2020 Jun 14.
In exposure for chronic pain, avoidance is often forbidden (extinction with response prevention; RPE) to prevent misattributions of safety. Although exposure is an effective treatment, relapse is common. Little is known about the underlying mechanisms of return of pain-related avoidance. We hypothesized that pain-related avoidance would recover when becoming available again after RPE and after unexpected pain episodes ("reinstatement"), especially when restricting avoidance during RPE (compared to instructing not to use it). In an operant pain-related avoidance conditioning paradigm, healthy volunteers used a robotic arm to perform various arm reaching movements differing in pain-effort trade-off. During acquisition, participants learned to avoid pain by performing more effortful movements. During RPE they only performed the formerly pain-associated movement under extinction, and were either forbidden (Restricted group) or merely instructed (Instructed group) not to perform other movements. One day later, we tested spontaneous recovery and reinstatement of pain-related fear and avoidance with availability of all movements. Results showed that pain-related fear and avoidance re-emerge after RPE, though not to pretreatment levels. The reinstatement manipulation had no additional effect. No group differences were observed. We discuss findings in the context of learning processes in (chronic) pain disability and relapse prevention in chronic pain treatment. Perspective: Using experimental models of relapse, we investigated the return of pain-related avoidance behavior after extinction with response prevention. Findings are potentially informative for clinicians performing exposure treatment with chronic pain patients.
在慢性疼痛的暴露治疗中，通常禁止回避（消退与反应预防；RPE）以防止安全的错误归因。尽管暴露治疗是一种有效的治疗方法，但复发很常见。对于疼痛相关回避恢复的潜在机制知之甚少。我们假设，在 RPE 后和意外疼痛发作后（“恢复”），当疼痛相关回避再次可用时，它会恢复，尤其是在 RPE 期间限制回避（与指示不要使用它相比）。在操作性疼痛相关回避条件反射范式中，健康志愿者使用机器人手臂执行各种不同疼痛-努力权衡的手臂伸展运动。在获得阶段，参与者通过执行更费力的运动来避免疼痛。在 RPE 期间，他们仅在消退下执行以前与疼痛相关的运动，并且被禁止（限制组）或仅被指示（指示组）不执行其他运动。一天后，我们测试了所有运动可用时疼痛相关恐惧和回避的自发恢复和恢复。结果表明，尽管没有恢复到治疗前的水平，但 RPE 后疼痛相关恐惧和回避会重新出现。恢复操作没有额外的效果。没有观察到组间差异。我们在（慢性）疼痛残疾的学习过程和慢性疼痛治疗中的复发预防的背景下讨论发现。观点：使用复发的实验模型，我们研究了消退与反应预防后的疼痛相关回避行为的恢复。这些发现可能为接受慢性疼痛患者进行暴露治疗的临床医生提供信息。
