Valued non-pain goals attenuate avoidance behavior in the context of pain

Background and aim. Fear-Avoidance models propose that dysfunctional beliefs about pain induce a pattern of defensive responses, possibly leading to the development, maintenance, and exacerbation of chronic pain disability. However, pain-related fear does not occur in a motivational vacuum, but in a context of multiple, often competing goals. Therefore, Fear-Avoidance models might benefit from including a motivational perspective. Methods. We used an adapted Voluntary Joystick Movement paradigm. In a within-subjects design (N=55) participants manipulated a joystick to the left/right in the experimental (competing goals) condition, and upward/downward in the control condition or vice versa. In the experimental condition, one movement (CS+) was followed by both a painful unconditioned stimulus (pain-US) and a monetary reward (reward-US), the other movement (CS-) was not. In the control condition, the CS+ movement was only followed by the pain-US, the CS- movement was not. During free choice trials after each block, participants performed either the CS+ or the CS- movement. Results. Participants chose to perform the CS+ movement more often in the experimental condition than in the control condition. Also, participants were slower initiating a CS+ than a CS- movement in the control condition, whereas in the experimental condition this difference in response latencies vanished. Conclusion. This study presents preliminary experimental support for the influence of motivational factors on pain avoidance. Being confronted with pain, including a valued non-pain goal attenuates avoidance behavior, as indicated by differential response latencies and choice behavior.status: publishe