Avoidance Behavioral Difference in Acquisition and Extinction of Pain-Related Fear.

Yuki Nishi,Michihiro Osumi,Satoshi Nobusako,Kenta Takeda,Shu Morioka

doi:10.3389/fnbeh.2019.00236

Abstract

Fear of movement-related pain leads to two types of avoidance behavior: excessive avoidance and pain-inhibited movement. Excessive avoidance is an absence of movement by fear, and pain-inhibited movements involve a change in motor behavior for the purpose of protecting the painful part. Here, we sought to clarify the acquisition process and adaptation of fear for each avoidance behavior. Thirty-one female and 13 male (age 20.9 ± 2.1 years) subjects could decide persistent behaviors: approach with an intense pain stimulus, pain-inhibited movement with weak pain stimulus, or excessive avoidance with no pain in acquisition and test phases. In the subsequent extinction phase, the pain stimulus was omitted. Subjects were divided into an approach group (n = 24), a pain-inhibited movement group (n = 10), and an excessive avoidance group (n = 10) by cluster analysis. The response latencies in approach and pain-inhibited movement groups were not affected by conditioned pain. The subjects in the excessive avoidance group exhibited delayed response latencies, and their high-fear responses remained in the acquisition, test, and extinction phases. In addition, the excessive avoidance group showed high harm avoidance and high trait anxiety. This study demonstrated that differences in pain-related avoidance behaviors are affected by psychological traits. Pain-related excessive avoidance behavior indicated a maladaptive fear, but pain-inhibited movement did not.

Highlights

Pain-related avoidance behaviors have short-term benefits which diminish movement-related pain and protect from further injury but sometimes become critical factors in the development or maintenance of chronic pain (Main and Watson, 1996; Pincus et al, 2006)
In the present study, using prior research that clarified the relationship between pain-related fear and movements as our foundation, we attempted to determine whether painrelated fear induced by an original paradigm can be used to identify individuals who engage in pain-inhibited movement or excessive avoidance behaviors during free decision making, and we examined psychological traits related to each behavior
We divided the subjects into three subgroups based on their avoidance times: cluster 1 (n = 10), the “excessive avoidance group”; cluster 2 (n = 10), the “paininhibited movement group”; and cluster 3 (n = 24), the “approach group.”

Summary

Introduction

Pain-related avoidance behaviors have short-term benefits which diminish movement-related pain and protect from further injury but sometimes become critical factors in the development or maintenance of chronic pain (Main and Watson, 1996; Pincus et al, 2006). Fear of movementrelated pain leads to two types of avoidance behaviors: excessive avoidance and pain-inhibited movement. Excessive avoidance is a passive behavior such as complete disuse of the affected part and movement cessation due to pain (Hadistavropoulos et al, 1999; Tan et al, 2001; Bruehl and Chung, 2006; Garcia-Campayo et al, 2007). Pain-inhibited movements, such as changes in motor behavior undertaken to protect the affected part (Thomas and France, 2007, 2008), entail a spectrum of movement deviations and a decrease of the movement velocity in clinical practice (van Dieën et al, 2018). Adaptation of pain-related fear has the key role of being the connection between avoidances and chronic pain (Vlaeyen and Linton, 2000).

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