Opposing effects of expectancy and somatic focus on pain
Open accessAbstract
High-pain expectancy increases pain and pain-related brain activity, creating a cycle of psychologically maintained pain. Though these effects are robust, little is known about how expectancy works and what psychological processes either support or mitigate its effects. To address this, we independently manipulated pain expectancy and "top-down" attention to the body, and examined their effects on both a performance-based measure of body-focus and heat-induced pain. Multi-level mediation analyses showed that high-pain expectancy substantially increased pain, replicating previous work. However, attention to the body reduced pain, partially suppressing the effects of expectancy. Furthermore, increased body-focus had larger pain-reducing effects when pain expectancy was high, suggesting that attempts to focus on external distractors are counterproductive in this situation. Overall, the results show that attention to the body cannot explain pain-enhancing expectancy effects, and that focusing on sensory/discriminative aspects of pain might be a useful pain-regulation strategy when severe pain is expected.
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Higher pain expectancy is associated with increases in subsequent pain experiences.
“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 [7]
Body awareness and pain perception are closely linked on a neuro-biological level, such that the enhancement of specific styles or dimensions of body awareness may facilitate the self-regulation of pain.
“Thus, body awareness and pain perception are closely linked on a neuro-biological level, such that the enhancement of specific styles or dimensions of body awareness may facilitate the self-regulation of pain.”
From Effects of mindfulness-based cognitive therapy on body awareness in patients with chronic pain and comorbid depression (2016) · cites this paper as Johnston et al., 2012
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“Applying such paradigms, it has been demonstrated that pain expectancy enhances evaluative pain-related brain regions and subsequent pain perception of painful stimuli (Sawamoto et al., 2000; Koyama et al., 2005; Keltner et al., 2006; Fairhurst et al., 2007; Moseley and Arntz, 2007; Johnston et al., 2012; Kong et al.,…”
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“Overall, the results show that attention to the body cannot explain pain enhancing expectancy effects, and that focusing on sensory/discriminative aspects of pain might be a useful pain-regulation strategy when severe pain is expected [65].”
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Human ventromedial prefrontal cortex lesions enhance expectation-related pain modulationPreprint
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“These findings align with previous reports indicating that focusing attention on a nociceptive stimulus exaggerates pain [6,23].”
BackgroundResultModulation of pain via expectation of its location
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“Finally, previous experimental studies have found positive correlation between attention to somatosensory input (a proxy of sensory weight; Trapp and Vilares 2020) and both analgesic (Johnston et al. 2012) and hyperalgesic (Buhle and Wager 2010) effects.”
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“63,65 However, it should be noted that the fear-avoidance relationship can be found in several individual networks (e.g., contemporaneous network of participants 4, 18, and 27, and temporal network of participants 12, 14, and 16).”
- Authors
- Johnston, N. E., Atlas, L. Y., & Wager, T. D.
- Affiliations
- Weill Cornell Medicine (US)
- New York University (US)
- University of Colorado Boulder (US)
- Corresponding author
- Wager, Tor D.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-06-19
- Volume
- 7
- Issue
- 6
- Pages
- e38854
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3378588
- OpenAlex
- W2128486889
- Cited by
- 53
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 1 · 2019: 2 · 2018: 8 · 2017: 3 · 2016: 5 · 2015: 3 · 2014: 4 · 2013: 6 · 2012: 1
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (MH076136)
- National Institute of Mental Health (MH076136, R01MH076136)
- National Institute on Drug Abuse (RC1DA028608, R01DA027794)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- pain anticipation, top-down attention, thermal pain, pain modulation, pain-related brain activity, distraction
- MeSH terms
- Adolescent, Adult, Attention, Brain, Female, Hot Temperature, Humans, Male, Middle Aged, Pain, Young Adult
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