(171) - Alterations in memories for fearful experiences among youth with chronic pain

Abstract

Interpretation of survival salient stimuli, such as the detection of threat, constitutes a fundamental protective mechanism in an organism. In chronic pain, this response mechanism becomes faulty, contributing to a distorted perception of threat. Stimuli that are improperly perceived as threatening can leave lasting memory traces that interfere with the recollection of actual pain experiences. In this study, we examined how adolescents with chronic pain encoded and retrieved memories of emotionally salient stimuli from a differential fear conditioning paradigm. Patients ages 10–24 (n = 33) and cohort matched healthy peers (HC, n = 14) participated in the “Screaming Lady” fear conditioning paradigm to examine contingency learning. Patients completed the Fear of Pain Questionnaire (FOPQ) and were examined across high (HF, n = 12), moderate (MF, n = 7), and low fear (LF, n = 12) levels, in comparison to the healthy counterparts. All participants were asked a series of questions pertaining to feelings of anxiety or unpleasantness regarding the conditioned stimulus (CS+) and neutral stimulus (CS-) on the day of the experiment and one month post-experiment via a telephone memory interview. High fear participants reported increased feelings of anxiety towards the CS- at the one-month follow up mark (P < .05), and reported marginally significant (P = .08) increased feelings of unpleasantness towards the CS-. An analysis of the reported unconditioned stimulus (UCS, unpleasant scream) frequency revealed that pain groups tended to report higher frequencies for the CS + than the control group. We also examined memory interviews qualitatively with NVivo software for memory accuracy, content, and affect. These initial findings suggest a distortion in memory of threat among pediatric chronic pain patients compared to healthy peers. In future work, we will investigate additional covariates such as state and trait anxiety to identify additional factors involved in the distortion of fear memories.