When the good gets bad…and sticks! Understanding and challenging (the spreading of) pain-related avoidance behavior

Summary

Growing evidence suggests that pain-related fear and avoidance behavior are more disabling than pain itself, and contribute to the transition from acute to chronic pain. When avoidance averts genuine bodily threat, it is highly adaptive. In chronic pain, when avoidance behavior spreads to behaviors that do not pose a threat to the body, it is no longer adaptive. Unbridled avoidance generalization may lead to excessive activity disengagement, culminating into a crippling disorder with substantial personal and societal impact. Avoidance behavior also encumbers the accurate disconfirmation of bodily threat, contributing to the self-perpetuating cycle of pain, fear, and disability, and likely complicating exposure treatment. Furthermore, the availability of the avoidance response itself after “response prevention with extinction” (RPE; e.g. exposure treatment) may constitute a context-switch leading to return of avoidance. Despite its prominence in chronic pain models, instrumental avoidance –a topic that has long fascinated researchers (and clinicians)– lacks systematic research due to the absence of appropriate experimental paradigms, leaving the mechanisms underlying its spreading and persistence poorly understood.
Therefore, I propose an innovative operant pain-related avoidance paradigm: a robotic arm-reaching task wherein pain can be avoided by performing more effortful movement trajectories (in terms of distance and resistive force) to reach a target. I will investigate (1) perceptual and conceptual spreading of avoidance behavior and hypothesize that poor safety learning in vulnerable individuals (high trait anxiety, pain catastrophizing, fear of pain and negative affectivity) leads to avoidance overgeneralization; (2) whether perceptual discrimination training (increasing proprioceptive precision) and positive affect/optimism induction attenuates the spreading of avoidance; (3) how cognitive load and motivational manipulations as well as positive affect/optimism induction alter the return of avoidance after RPE. A better understanding of the underlying mechanisms contributing to pain-related avoidance generalization and relapse opens new avenues for treatment optimization and prevention of chronic pain.

Details

Project number

452-17-002

Main applicant

Dr. A. Meulders

Affiliated with

Katholieke Universiteit Leuven, Faculteit Psychologie en Pedagogische Wetenschappen, Research Center for Stress, Health and Well-being

Team members

I. Gatzounis, E.A.A. Glogan, Dr. A. Meulders, Dr. A. Meulders, K. Vandael

Duration

01/11/2017 to 30/11/2022