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Approach and Avoidance Behavior in Chronic Back Pain: The Role of Pavlovian-Instrumental Transfer

F. Nees, M. Ruttorf, X. Fuchs and M. Rance

Psychopysiology, 52 (S1), p.S75

Chronic pain may predominantly or entirely depend on maladaptive learning processes - both in a respondent and operant fashion. These learning-related alterations may contribute to a mismatch in approach/avoidance behavior, most relevant to the development and maintenance of chronic pain states, and with the prediction of pain and analgesia, as well as reward and pain relief processing as possibly major factors. In the present study, we aimed at elucidating how exactly these mechanisms interact, on a behavioral, peripheral and central level, to produce maladaptive behavior in chronic back pain. We used a pain-unrelated (monetary) reward and a newly developed pain-related (pain relief) Pavlovian-instrumental transfer (PIT) task during functional magnetic resonance imaging in patients with chronic back pain and healthy controls. Moreover, participants underwent a newly developed pain-related approach-avoidance task in the laboratory. First results indicate that chronic back pain patients show reduced painunrelated appetitive approach involving reduced PIT, and increased pain-relief avoidance behavior. This was represented by increased skin conductance responses, increased response times, and enhanced response in the amygdala, insula and orbitofrontal cortex, but reduced response in the striatum and prefrontal cortex. These data may have important clinical implications contributing to the development, and more specifically explain the maintenance of chronic pain.

Contact: Prof. Dr. Frank Zöllner last modified: 20.08.2019
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