Classical conditioning of analgesic and hyperalgesic pain responses without conscious awareness
Open accessAbstract
Significance: It is unclear to what extent new learning can take place outside of conscious awareness. In the present study, we used psychophysical measures and classical conditioning to establish whether psychologically mediated analgesic and hyperalgesic responses could be acquired by unseen (subliminally presented) stimuli. Our study demonstrates that analgesia and hyperalgesia can be learned without conscious awareness, suggesting that higher-order cognitive processes may be affected by implicit learning mechanisms.
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Because expectations of low pain are more easily extinguished and more sensitive to sensory evidence, the positive PE condition was more vulnerable to an unmeasured variable than the negative PE condition.
“It is plausible that because expectations of low pain are more easily extinguished and more sensitive to sensory evidence18–21, the corresponding positive PE condition was more vulnerable to an unmeasured variable than the negative PE condition.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [19]
The Results report a larger hyperalgesic than analgesic effect, and the Discussion suggests threat-related cues may be more salient than safety-related cues. Neither passage establishes that expectations of low pain are more easily extinguished or more sensitive to sensory evidence. The cited paper also does not assess vulnerability to an unmeasured variable; the citing authors present that as their own inference. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn a subliminal pain conditioning procedure, nocebo responses have been shown to be significantly stronger than placebo responses.
“Nocebo responses have been shown to be significantly stronger than placebo responses in a subliminal pain conditioning procedure, and this finding was related to the higher salience of nocebo cues19.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [19]
The Results report that the hyperalgesic effect was significantly larger than the analgesic effect (P < 0.001), supporting the comparison in the claim. The Discussion suggests that threat-related cues may be more salient during rapid exposures, but presents this as a possible explanation, not an established reason for the difference. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNocebo responses are stronger than placebo responses.
“Nocebo responses are stronger, more difficult to extinguish and less sensitive to sensory evidence than placebo responses8,18–20.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [19]
Nocebo responses are more difficult to extinguish than placebo responses.
“Nocebo responses are stronger, more difficult to extinguish and less sensitive to sensory evidence than placebo responses8,18–20.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [19]
The Results and Discussion report that conditioned hyperalgesic responses were stronger than analgesic responses, but neither section compares how readily the two responses extinguish. A search for extinction and resistance to extinction found no passage supporting the attributed comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measuredNocebo responses are less sensitive to sensory evidence than placebo responses.
“Nocebo responses are stronger, more difficult to extinguish and less sensitive to sensory evidence than placebo responses8,18–20.”
From Boundary effects of expectation in human pain perception (2019) · cites this paper as [19]
The Discussion (page unavailable) says conditioned hyperalgesia was stronger than analgesia, but does not compare how sensitive the two responses were to sensory evidence. The Results (page unavailable) report that perceived pain during conditioning was associated with conditioned responses, without establishing a difference in sensitivity between them. A search for the claimed comparison found no supporting passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Jensen, K., Kirsch, I., Odmalm, S., Kaptchuk, T. J., & Ingvar, M.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Karolinska Institutet (SE)
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2015-05-15
- Volume
- 112
- Issue
- 25
- Pages
- 7863-7867
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC4485119
- OpenAlex
- W1570298792
- Cited by
- 130
- References
- 38
- Citations by year
- 2025: 6 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 13 · 2020: 14 · 2019: 23 · 2018: 23 · 2017: 16 · 2016: 13 · 2015: 7
- FWCI
- 11.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Complementary and Integrative Health (K24AT004095, 2K24 AT004096)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- classical conditioning, conditioned analgesia, subliminal perception, conscious awareness, extinction, conditioned pain modulation
- MeSH terms
- Analgesia, Awareness, Conditioning, Classical, Humans, Hyperalgesia, Pain
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