Abstract
Chronic pain may sap the motivation for positive events and stimuli. This may lead to a negative behavioural cycle reducing the establishment of appetitive habitual engagement. One potential mechanism for this might be biased learning. In our experiment, chronic back pain patients and healthy controls completed an appetitive Pavlovian-instrumental transfer procedure. We examined participants` behaviour and brain activity and reported pain, depression and anxiety. Patients showed reduced habitual behaviour and increased responses in the hippocampus than controls. This behavioural bias was related to motivational value and reflected in the updating of brain activity in prefrontal–striatal–limbic circuits. Moreover, this was influenced by pain symptom duration, depression and anxiety (explained variance: up to 50.7%). Together, findings identify brain-behaviour pathways for maladaptive habitual learning and motivation in chronic back pain, which helps explaining why chronic pain can be resistant to change, and where clinical characteristics are significant modulators.
Highlights
Chronic pain may sap the motivation for positive events and stimuli
No significant main effect of group was found for other brain regions of interest (ROIs) like the insula, amygdala, prefrontal cortex (PFC), ventral striatum (VS) and anterior cingulate cortex (ACC)
Voluntary behaviour is focused on pain and pain-related stimuli and this might occur at the cost of focusing on positive events and stimuli
Summary
Chronic pain may sap the motivation for positive events and stimuli. This may lead to a negative behavioural cycle reducing the establishment of appetitive habitual engagement. Patients showed reduced habitual behaviour and increased responses in the hippocampus than controls This behavioural bias was related to motivational value and reflected in the updating of brain activity in prefrontal–striatal–limbic circuits. Through a negative pain-reinforcing cycle, chronic pain patients mostly develop maladaptive pain managing behaviour, which is in conflict with these clinical interventions (e.g.,2) This may be due to a sap in motivation for positive events and stimuli. While in healthy individuals positive stimuli such as pleasurable food were shown to reduce acute pain perception[5], chronic pain patients might benefit less from these positive stimuli and events, but rather focus on pain-related aspects of r elief[6,7] This is indicated by findings that showed that (chronic) pain is associated with the inhibition of behavioural responses to obtain a reward (e.g.,8). Pavlovian-conditioned responses may be evolutionarily hard wired and explicitly linked to incentive, motivational, valence[12], and this is an important dimension in the modulation of cognitively controlled b ehaviour[13,14,15]
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