Why Harmless Sensations Might Hurt in Individuals with Chronic Pain: About Heightened Prediction and Perception of Pain in the Mind

In individuals with chronic pain harmless bodily sensations can elicit anticipatory fear of pain resulting in maladaptive responses such as taking pain medication. Here, we aim to broaden the perspective taking into account recent evidence that suggests that interoceptive perception is largely a con...

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Bibliographic Details
Published in:Frontiers in psychology Vol. 7; p. 1638
Main Authors: Hechler, Tanja, Endres, Dominik, Thorwart, Anna
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 25.10.2016
Subjects:
Bayes Theorem
Chronic Pain
interoception
interoceptive predictive coding
Pain Perception
Psychology
interoceptive predictive coding
chronic pain
interoception
active inference
pain perception
Bayes theorem
ISSN:1664-1078, 1664-1078
Online Access:Get full text
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Summary:In individuals with chronic pain harmless bodily sensations can elicit anticipatory fear of pain resulting in maladaptive responses such as taking pain medication. Here, we aim to broaden the perspective taking into account recent evidence that suggests that interoceptive perception is largely a construction of beliefs, which are based on past experience and that are kept in check by the actual state of the body. Taking a Bayesian perspective, we propose that individuals with chronic pain display a heightened prediction of pain [prior probability ], which results in heightened pain perception [posterior probability ] due to an assumed link between pain and a harmless bodily sensation [ ]. This pain perception emerges because their mind infers pain as the most likely cause for the sensation. When confronted with a mismatch between predicted pain and a (harmless bodily) sensation, individuals with chronic pain try to minimize the mismatch most likely by active inference of pain or alternatively by an attentional shift away from the sensation. The results in activities that produce a stronger sensation that will match with the prediction, allowing subsequent perceptual inference of pain. Here, we depict heightened pain perception in individuals with chronic pain by reformulating and extending the assumptions of the interoceptive predictive coding model from a Bayesian perspective. The review concludes with a research agenda and clinical considerations.
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This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology
Edited by: Gian Mauro Manzoni, Università degli Studi eCampus, Italy
Reviewed by: Karl Friston, University College London, UK; Emanuele Giusti, Catholic University of the Sacred Heart, Italy; Charles B. Hall, Albert Einstein College of Medicine, USA
ISSN:1664-1078
1664-1078
DOI:10.3389/fpsyg.2016.01638