Background & Aims

Helplessness is an important predictor of pain severity in chronic pain patients [1]. Learned helplessness describes the generalization of unfavorable behavior after experiencing a loss of control and has more recently been linked chronic pain: stress by reoccurring pain can lead to decreased self-efficacy and motivation [2]. The focus of the project here is the modulation of acute pain by helplessness and the ensuing behavioral consequences. We induce helplessness through uncontrollable pain and evaluate resulting pain modulatory processes. Importantly we evoke helplessness only in one experimental group while the comparison group learns to avoid painful stimuli, experiencing control over pain. Afterwards we let participants of both groups move freely in a computerized environment to measure learning and exploration behavior. We hypothesize that apart from differences in pain and relief ratings, group differences will emerge as different behavioral patterns in the test environment.

Methods

In the first phase of the task the control group can learn to avoid painful heat stimuli and obtain relieving cool stimuli in a cue-button matching task. Subjects in the helpless group receive the same sequence of stimuli as their matched counterpart, but independent of their actions. Pain and relief ratings are collected in each trial; control and confidence ratings after each run. In the second phase each trial starts with an ongoing painful heat stimulus. During stimulation a Pacman-like character can be moved over a computerized grid. Some fields in the grid hide probabilistic reliefs and are highlighted if moved over them. If stopped on those fields either the painful heat stimulus continues or it is ramped down to induce relief. If stopped on other fields or if continuing moving relief cannot be obtained. We will compare pain and relief ratings between the control and the helpless group. Further we will analyze number, duration and efficiency of movement during the second phase.

Results

As data collection is still ongoing we report here the current status of N = 12 (study aim N = 86). Results are currently descriptive, rather than test on significance due to current power limitations. The control group indicated higher control and confidence compared to the helpless group. In addition the control group felt more capable to reduce pain intensity, but also expressed to have more difficulties enduring pain. The yoked participants report lower relief intensity than the control group. Interestingly the helpless group also shows lower pain ratings compared to the control group. In the second phase, pain ratings vary unsystematically between groups. Both groups show an increase of pain during trials and a decrease across runs. Notably both groups show an equal amount of successive escape trials, but the helpless group performed more steps per minute compared to the control group resulting in an overall less efficient escape behavior in the helpless group.

Conclusions

The loss of control in one context can have relevant consequences for behavior in subsequent situations. In our experimental setup we test the induction of learned helplessness via uncontrollable pain and relief stimuli comparing behavioral patterns of a helpless and a control group. So far our data suggest that a group experiencing loss of control shows a devaluation of positive outcomes (relief) as well as blunting of responses towards negative outcomes (pain). This fits in well with models on pain as a learning signal as the opportunity and controllability of the environment are theorized to modulate pain [3]. In addition we observe less efficient behavior in the helpless group in the test environment hinting to a generalization of the helplessness effects. These data support the link between uncontrollable pain and behavioral alterations hypothesized by the learned helplessness model of chronic pain.

References

1.Craner, J.R. et al. (2016) Rumination, Magnification, and Helplessness: How do Different Aspects of Pain Catastrophizing Relate to Pain Severity and Functioning? The Clinical Journal of Pain 32, 1028–1035
2.Yessick, L.R. and Salomons, T.V. (2022) The chronic disease helplessness survey: developing and validating a better measure of helplessness for chronic conditions. PR9 7, e991
3.Seymour, B. (2019) Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 101, 1029–1041

Presenting Author

Marie Habermann

Poster Authors

Marie Habermann

MSc

University Medical Center Hamburg-Eppendorf

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial