This current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and...Show moreThis current study investigated the relationship between level of pain, expectancies, and avoidance in individuals with chronic low back pain. Research showed that individually expectancies and avoidance behaviour influence pain experience. However, there seems to be little research into the combined influence. Seeing that research also showed that pinpointing a cause for the chronic low back pain is difficult, this study aimed to give insight into interacting factors that influence chronic low back pain. To gather data participants (N=18) filled in a questionnaire five times a day for two weeks. This provided insight into their levels of pain in the morning and the evening, if they expected to experience pain and if they were more likely to avoid movements, they expected to be painful. These statements were answered with answering scales, ranging from 0 (not at all) to 6 (extremely), given how likely that statement was for the participant. A mediation analysis inspecting possible relations between the level of pain and expectancies, the level of pain and avoidance, and the level of pain, expectancies and avoidance yielded no significant relations. Therefore, it could not be concluded that avoidance and/or expectancy are influencing the level of pain in the evening when compared to the level of pain in the morning. There were two significant findings, the impact of level of pain in the morning on expectancies and the impact of expectancies on avoidance. These findings are in line with what was found in existing literature and give incitement for further research on this topic. Another incitement for further research is the small sample used in this current study. The implication for the scientific field therefore is to perform this study on a bigger sample. Another consideration for further research would be to try and use a more diverse sample in both age and gender, this to make a more representative sample to draw conclusions for the general population. This could also lead to more substantial implications for the clinical field since this study did not have significant results.Show less
Nocebo hyperalgesia can be defined as an increased sensitivity to pain caused by a nocebo effect. Expectancies are fundamental to nocebo effects. How pain is experienced can be modified by...Show moreNocebo hyperalgesia can be defined as an increased sensitivity to pain caused by a nocebo effect. Expectancies are fundamental to nocebo effects. How pain is experienced can be modified by expectancies and avoidance behavior. This is the basis of the fear-avoidance model. The aim of this study was to gain a better understanding of the relationship between pain, expectancies and avoidance behavior. More specifically, we wanted to assess whether negative expectancies induce nocebo hyperalgesia, and whether nocebo hyperalgesia predicts avoidance. A total of 116 participants were included in the study. Participants were randomly assigned to either the control (n = 58) or nocebo group (n = 58). The pain stimuli were administered electrically. In the nocebo group, expectancies about pain stimuli were induced by verbal suggestions and conditioning. The verbal suggestions included telling participants that a specific color cue would increase the intensity. The conditioning consisted of consistently pairing a specific color cue with a higher stimulus. In the control group, no expectancies were induced and stimuli were administered randomly. Avoidance was measured through a pain avoidance task for which the Tower of Hanoi was used. Results indicated a significant interaction between type of color cue and group (F(1,114) = 34.08, p < .001, ηp2 = .230), indicating a significant difference between the pain ratings of the color cues of both groups. Participants in the nocebo group gave higher pain ratings than the control group, indicating that nocebo hyperalgesia increased when negative expectancies were induced. However, nocebo hyperalgesia did not predict avoidance behavior (χ² (1) = .51, p = .477). The results are in line with studies on nocebo effects on pain and add to the importance of verbal suggestions. As pain can be hugely modified by expectancies, it is recommended for clinicians to be mindful of their communication with patients. By effectively managing patients’ expectancies, nocebo effects can be minimized. Results do not completely corroborate the fear-avoidance model. Therefore, future research should focus on developing objective measurement instruments of avoidance. This could provide more insight into the development of pain and improve pain treatments.Show less
