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Underpredicting pain: an experimental investigation into the benefits and risks
Abstract
ABSTRACT: Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (ie, assimilation effects), as seen with placebo effects. However, in case of large expectation-experience discrepancies, experiences might change away from what is expected (ie, contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. In addition, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (study 1: n = 81 and study 2: n = 123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; study 2 only), or nonpainful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (ie, assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction vs medium underprediction generally did not differ. Moreover, study 2 provided some indications for reduced heart rate and skin conductance levels but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (ie, cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.
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“Experimental and diary studies have shown that higher pain expec tancy is associated with increases in (subsequent) pain experiences [4,7 -10].”
From Nocebo hyperalgesia and other expectancy-related factors in daily fibromyalgia pain: Combining experimental and electronic diary methods (2024) · cites this paper as [10]
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Metadata
- Authors
- Peerdeman, K. J., Geers, A. L., Della Porta, D., Veldhuijzen, D. S., & Kirsch, I.
- Affiliations
- Leiden University (NL)
- University of Toledo (US)
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
- Harvard University (US)
- Corresponding author
- Peerdeman, Kaya J.
- Venue
- Pain
- Published
- 2021-01-15
- Volume
- 162
- Issue
- 7
- Pages
- 2024-2035
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W3122034998
- Cited by
- 25
- References
- 61
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 1
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (453-16-004)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Keywords
- pain anticipation, contrast effects, assimilation effect, placebo effect, verbal suggestion, pain intensity, fear of pain, pain unpleasantness, skin conductance, heart rate
- MeSH terms
- Fear, Humans, Pain, Pain Measurement, Risk Assessment, Pain Perception
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