Implicit operant learning of pain sensitization

Operant conditioning mechanisms have been demonstrated to be important in the development of chronic pain behavior, but it is not clear whether and how this extends to pain perception itself. The fear-avoidance theory suggests that hypersensitivity may be induced by anticipatory pain avoidance learned through negative reinforcement by acute reductions of pain and fear. But the precise mechanism of the assumed 'sensory decalibration' has not been specified. The present study with healthy subjects investigated whether operant learning of enhanced short-term sensitization may provide the 'proximal' mechanism and whether gradual learning of hypersensitivity can take place without subjects' awareness. We used an experimental model of implicit learning based on a behavioral adjustment method of sensitization measurement developed and validated previously, combining it with standard methods of operant response shaping of increased sensitization or habituation. Results indicated that operant discrimination training with reinforcement of short-term sensitization in the seconds range can produce gross up or down changes in sensitivity within an hour without subjects' awareness of reinforcement contingencies. Consequently, implicit learning of enhanced pain sensitization may be a suitable model to investigate operant plasticity of pain perception in addition to basic sensory and neuronal mechanisms and to link these with the clinical construct of pain-fear avoidance.