PubMed · 14416285
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S LEVINE, S J ENGLAND. 1960. Temporal factors in avoidance learning.. https://doi.org/10.1037/h0046423
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Termination of a painful or unpleasant event can be rewarding. However, whether the brain treats relief in a similar way as it treats natural reward is unclear, and the neural processes that underlie its representation as a motivational goal remain poorly understood. We used fMRI (functional magnetic resonance imaging) to investigate how humans learn to generate expectations of pain relief. Using a pavlovian conditioning procedure, we show that subjects experiencing prolonged experimentally induced pain can be conditioned to predict pain relief. This proceeds in a manner consistent with contemporary reward-learning theory (average reward/loss reinforcement learning), reflected by neural activity in the amygdala and midbrain. Furthermore, these reward-like learning signals are mirrored by opposite aversion-like signals in lateral orbitofrontal cortex and anterior cingulate cortex. This dual coding has parallels to 'opponent process' theories in psychology and promotes a formal account of prediction and expectation during pain.
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OBJECTIVE: This study investigated the quality criteria of a screening procedure used to identify fear-avoidance beliefs. METHODS: The translated version of the original FABQ was submitted to 302 patients with chronic back pain. Additionally, self-assessment protocols were used to document information on disease history, pain-specific parameters, extent of subjectively experienced impairment, and depressive symptoms. RESULTS: Correlation statistical analysis confirmed the relevance of fear-avoidance beliefs for the impairment as experienced by the patients with back pain. The FABQ proved to be a better predictor of subjectively experienced impairment than pain intensity or affective/emotional orientation. CONCLUSIONS: Fear-avoidance beliefs represent significant cognitive factors for chronification of back pain. The results demonstrated the practicability, reliability, and validity of the questionnaire to assess fear-avoidance beliefs.