The role of expectations, control and reward in the development of pain persistence based on a unified model
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
Figures
Figure 1
Integrative psychobiological pain model, incorporating the motivation-decision model (blue) (Fields, 2006), the fear-avoidance model (green) (Vlaeyen et al., 1995), learned helplessness (orange) (Maier and Seligman, 1976) and a Bayesian expectation integration model (yellow) (Büchel et al., 2014).
The state of the model depicts the situation for acute pain, with a major noxious input that generates pain via nociceptive processing. In addition, acute pain already generates negative expectations and some loss of control. Dashed arrows depict minor contributions, solid arrows depict medium contributions and bold arrows strong contributions.
Figure 2
Over time and with ongoing pain persistence, the influence of nociceptive processing on pain gets weaker and at the same time, pain is maintained by fear of agency (Fear-avoidance model) and lack of control (Learned helplessness model).
Importantly, the model suggests that both aspects act through the arbitrator of the Motivation-decision model. In addition, negative expectations can increase pain through integration with nociceptive input. Dashed arrows depict minor contributions, solid arrows depict medium contributions and bold arrows strong contributions.
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The role of expectations, control and reward in the development of pain persistence based on a unified model
eLife 12:e81795.
https://doi.org/10.7554/eLife.81795
