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Papers of the Week

Papers: 21 Oct 2023 - 27 Oct 2023

2023 Oct 23

J Pain


Understanding the role of expectancy, anticipatory anxiety and attention bias in nocebo hyperalgesia: A gaze-contingent attention bias modification study.


Rooney T, Sharpe L, Todd J, Livesey E, Colagiuri B


Nocebo effects in pain (nocebo hyperalgesia) have been thoroughly researched, and negative expectancies have been proposed as a key factor in causing nocebo hyperalgesia. However, little is known about the psychological mechanisms by which expectations exacerbate the perception of pain. A potential mechanism that has been proposed within wider pain research is pain-related attention. The aim of the present study was thus to explore whether attention bias to pain influenced nocebo hyperalgesia. One-hundred and thirty-four healthy participants were randomised in a 2 (attention bias training: towards vs. away from pain) x 2 (nocebo condition: nocebo vs. control) design. Pain-related attention bias was manipulated through a novel, partially gaze-contingent dot-probe task. Participants then completed either a nocebo instruction and conditioning paradigm or a matched control condition. Primary outcomes were measures of expectancy, anticipatory anxiety and pain intensity completed during a nocebo test phase. Results showed that the attention bias manipulation was unsuccessful in inducing attention biases either towards or away from pain. The nocebo paradigm induced significantly greater expectancy, anticipatory anxiety and pain intensity for the nocebo groups compared to control groups. In a post-hoc analysis of participants with correctly induced attention biases, attention bias towards pain amplified nocebo hyperalgesia, expectancy and anticipatory anxiety relative to attention bias away from pain. The results are consistent with the expectancy model of nocebo effects and additionally identify anticipatory anxiety as an additional factor. Regarding attention bias, research is needed to develop reliable means to change attention sample-wide to corroborate the present findings. PERSPECTIVE: This article explores the role of attention bias, expectancy and anticipatory anxiety in nocebo hyperalgesia. The study shows that expectancy can trigger anticipatory anxiety that exacerbates nocebo hyperalgesia. Further, successful attention bias training towards pain heightens nocebo hyperalgesia. These findings identify candidate psychological factors to target in minimising nocebo hyperalgesia.