Labrenz Franziska, Kalenbach Anne, Elsenbruch Sigrid, Icenhour Adriane
Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.
Department of Affective Neuroscience, Ruhr University Bochum, Universitaetsstrasse 105, 44789, Bochum, Germany.
Sci Rep. 2025 Jul 24;15(1):27001. doi: 10.1038/s41598-025-10499-9.
Along the gut-brain axis, visceral pain demonstrably evokes emotional learning and memory processes shaping behavior in clinically relevant ways. Avoidance motivated by learned fear may constitute a major obstacle to treatment success in extinction-based interventions. However, the effects of avoidance on visceral pain-related fear extinction remain poorly understood. By implementing an ecologically valid experimental protocol, we investigated how costly avoidance affects the modulation and extinction of visceral pain-related fear. Thirty-three healthy volunteers underwent conditioning with visual cues (conditioned stimuli; CS,CS) consistently followed by visceral pain or remaining unpaired. During avoidance, participants decided to avoid or receive pain upon confronting CS. Avoidance decisions resulted in pain omission in some trials, while in others, participants experienced unpredictable pain. During extinction, CS were presented unpaired. CS valence, fear, and trial-by-trial decisions were analyzed. Avoidance decisions depended on prior experiences, with the highest probability of avoidance following successful pain omission. Negative CS valence and fear remained elevated across avoidance and extinction. Learned fear and more avoidance decisions explained 57% variance in sustained CS fear. Our findings indicate that avoidance, which provides short-term absence of pain even when followed by unpredictable pain, motivates its maintenance. However, it perpetuates pain-related fear and may impede extinction, with implications for persisting symptoms and therapeutic outcomes in chronic visceral pain.
沿着肠-脑轴，内脏痛明显会引发情绪学习和记忆过程，以临床相关的方式塑造行为。基于习得性恐惧的回避可能构成基于消退的干预措施治疗成功的主要障碍。然而，回避对内脏痛相关恐惧消退的影响仍知之甚少。通过实施一个生态有效的实验方案，我们研究了代价高昂的回避如何影响内脏痛相关恐惧的调节和消退。33名健康志愿者接受了视觉线索（条件刺激；CS）的条件作用，CS始终伴随着内脏痛或不配对。在回避过程中，参与者在面对CS时决定回避或接受疼痛。回避决定在一些试验中导致疼痛遗漏，而在另一些试验中，参与者经历了不可预测的疼痛。在消退过程中，CS不配对呈现。分析了CS效价、恐惧和逐次试验的决定。回避决定取决于先前的经历，在成功避免疼痛后回避的可能性最高。在回避和消退过程中，负性CS效价和恐惧仍然升高。习得性恐惧和更多的回避决定解释了持续CS恐惧中57%的变异。我们的研究结果表明，回避即使在随后伴有不可预测的疼痛时也能提供短期的疼痛缺失，从而促使其持续存在。然而，它使与疼痛相关的恐惧持续存在，并可能阻碍消退，这对慢性内脏痛的持续症状和治疗结果具有启示意义。
