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Startle modulation by heat pain with varying threat levels in chronic pain patients and pain-free controls

Authors Horn-Hofmann C, Wolf D, Wolff S, Heesen M, Knippenberg-Bigge K, Lang PM, Lautenbacher S

Received 8 March 2017

Accepted for publication 23 June 2017

Published 28 July 2017 Volume 2017:10 Pages 1787—1800

DOI https://doi.org/10.2147/JPR.S136416

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr E. Alfonso Romero-Sandoval

C Horn-Hofmann,1 D Wolf,1 S Wolff,1 M Heesen,2 K Knippenberg-Bigge,3 P M Lang,3 S Lautenbacher1

1Department of Physiological Psychology, University of Bamberg, Germany; 2Department of Anesthesiology and Pain Therapy, Kantonsspital Baden, Switzerland; 3Department of Anesthesiology and Pain Therapy, Sozialstiftung Bamberg, Bamberg, Germany

Background:
Empirical evidence suggests that affective responses to pain are changed in chronic pain. The investigation of startle responses to pain might contribute to clarifying whether such alterations also expand to motivational defensive reactions. We aimed at comparing startle responses to tonic heat pain with high threat (HT) or low threat (LT) in patients with chronic musculoskeletal pain and controls. As pain-related anxiety and catastrophizing are typically elevated in chronic pain, we expected to find stronger startle responses in patients specifically under experimental HT.
Methods: Patients with chronic musculoskeletal, preferentially, back pain (N = 19) and matched pain-free controls (N = 19) underwent two pain-related threat conditions (high and low) in balanced order. Only, in the HT condition, 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle responses to loud tones were always assessed prior to a potential temperature increase in the phase of anticipation and were recorded by surface electromyogram.
Results: Surprisingly, we observed no differences in startle responses and ratings of emotional and pain responses between patients and controls despite significantly higher pain-related anxiety and catastrophizing in the patients. Overall, startle was potentiated in the HT condition, but only in participants who started with this condition.
Conclusion: Our results suggest that, in general, patients with pain are not more responsive emotionally to experimental threat manipulations despite elevated pain anxiety and catastrophizing. Instead, exaggerated responses in patients might be triggered only by individual concerns relating to pain, which are not sufficiently mirrored by our threat paradigm.

Keywords: musculoskeletal pain, catastrophizing, anxiety, defensive motivation, experimental pain, startle reflex, threat induction

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