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Can pain or hyperalgesia be a classically conditioned response in humans? A systematic review and meta-analysis

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dc.contributor.authorMadden, V.J.
dc.contributor.authorHarvie, D.S.
dc.contributor.authorParker, R.
dc.contributor.authorJensen, K.B.
dc.contributor.authorVlaeyen, J.W.S.
dc.contributor.authorMoseley, G.L.
dc.contributor.authorStanton, T.R.
dc.date.issued2016
dc.descriptionData source: supplementary data, https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnv044
dc.description.abstractBackground. Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent amplification of pain, or evocation of pain in the absence of nociception. Methods. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or amplify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Results. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia; one did not. Pooled effects (n58 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95%CI: 4.00–10.80] on a 0–100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. Conclusion. The existing literature suggests that classical conditioning can amplify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.
dc.identifier.citationPain Medicine, 2016; 17(6):1094-1111
dc.identifier.doi10.1093/pm/pnv044
dc.identifier.issn1526-2375
dc.identifier.issn1526-4637
dc.identifier.urihttps://hdl.handle.net/11541.2/127341
dc.language.isoen
dc.publisherOxford University Press
dc.relation.fundingOppenheimer Memorial Trust (South Africa)
dc.relation.fundingResearch Foundation Flanders (FWO-Vlaanderen), Belgium Odysseus Grant, "The Psychology of Pain and Disability Research Program"
dc.relation.fundingNHMRC 1061279
dc.relation.fundingNHMRC 1054041
dc.relation.fundingIASP
dc.relation.fundingSouth African Society of Physiotherapy
dc.relation.fundingNHMRc 1047317
dc.rightsCopyright 2015 American Academy of Pain Medicine Access Condition Notes: Postprint only available on Open Access
dc.source.urihttp://dx.doi.org/10.1093/pm/pnv044
dc.subjectpain
dc.subjectclassical conditioning
dc.subjectPavlovian conditioning
dc.subjectassociative learning
dc.subjecthyperalgesia
dc.subjectallodynia
dc.titleCan pain or hyperalgesia be a classically conditioned response in humans? A systematic review and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished
ror.fileinfo12153797980001831 13197009890001831 9916138292001831_12153797980001831_13153807570001831_CS
ror.mmsid9916138292001831

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