Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear
Abstract Along the gut-brain axis, visceral pain demonstrably evokes emotional learning and memory processes shaping behavior in clinically relevant ways. Avoidance motivated by learned fear may constitute a major obstacle to treatment success in extinction-based interventions. However, the effects...
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Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
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| Online Access: | https://doi.org/10.1038/s41598-025-10499-9 |
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| author | Franziska Labrenz Anne Kalenbach Sigrid Elsenbruch Adriane Icenhour |
| author_facet | Franziska Labrenz Anne Kalenbach Sigrid Elsenbruch Adriane Icenhour |
| author_sort | Franziska Labrenz |
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| description | Abstract Along the gut-brain axis, visceral pain demonstrably evokes emotional learning and memory processes shaping behavior in clinically relevant ways. Avoidance motivated by learned fear may constitute a major obstacle to treatment success in extinction-based interventions. However, the effects of avoidance on visceral pain-related fear extinction remain poorly understood. By implementing an ecologically valid experimental protocol, we investigated how costly avoidance affects the modulation and extinction of visceral pain-related fear. Thirty-three healthy volunteers underwent conditioning with visual cues (conditioned stimuli; CS+,CS−) consistently followed by visceral pain or remaining unpaired. During avoidance, participants decided to avoid or receive pain upon confronting CS+. Avoidance decisions resulted in pain omission in some trials, while in others, participants experienced unpredictable pain. During extinction, CS were presented unpaired. CS valence, fear, and trial-by-trial decisions were analyzed. Avoidance decisions depended on prior experiences, with the highest probability of avoidance following successful pain omission. Negative CS+ valence and fear remained elevated across avoidance and extinction. Learned fear and more avoidance decisions explained 57% variance in sustained CS+ fear. Our findings indicate that avoidance, which provides short-term absence of pain even when followed by unpredictable pain, motivates its maintenance. However, it perpetuates pain-related fear and may impede extinction, with implications for persisting symptoms and therapeutic outcomes in chronic visceral pain. |
| format | Article |
| id | doaj-art-1d0537e13e464aaa9d8fee073f60eca3 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-1d0537e13e464aaa9d8fee073f60eca32025-08-20T04:02:46ZengNature PortfolioScientific Reports2045-23222025-07-0115111610.1038/s41598-025-10499-9Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fearFranziska Labrenz0Anne Kalenbach1Sigrid Elsenbruch2Adriane Icenhour3Department of Medical Psychology and Medical Sociology, Ruhr University BochumDepartment of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-EssenDepartment of Medical Psychology and Medical Sociology, Ruhr University BochumDepartment of Affective Neuroscience, Ruhr University BochumAbstract Along the gut-brain axis, visceral pain demonstrably evokes emotional learning and memory processes shaping behavior in clinically relevant ways. Avoidance motivated by learned fear may constitute a major obstacle to treatment success in extinction-based interventions. However, the effects of avoidance on visceral pain-related fear extinction remain poorly understood. By implementing an ecologically valid experimental protocol, we investigated how costly avoidance affects the modulation and extinction of visceral pain-related fear. Thirty-three healthy volunteers underwent conditioning with visual cues (conditioned stimuli; CS+,CS−) consistently followed by visceral pain or remaining unpaired. During avoidance, participants decided to avoid or receive pain upon confronting CS+. Avoidance decisions resulted in pain omission in some trials, while in others, participants experienced unpredictable pain. During extinction, CS were presented unpaired. CS valence, fear, and trial-by-trial decisions were analyzed. Avoidance decisions depended on prior experiences, with the highest probability of avoidance following successful pain omission. Negative CS+ valence and fear remained elevated across avoidance and extinction. Learned fear and more avoidance decisions explained 57% variance in sustained CS+ fear. Our findings indicate that avoidance, which provides short-term absence of pain even when followed by unpredictable pain, motivates its maintenance. However, it perpetuates pain-related fear and may impede extinction, with implications for persisting symptoms and therapeutic outcomes in chronic visceral pain.https://doi.org/10.1038/s41598-025-10499-9AvoidanceExtinctionFear conditioningGut-brain axisPain-related fearVisceral pain |
| spellingShingle | Franziska Labrenz Anne Kalenbach Sigrid Elsenbruch Adriane Icenhour Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear Scientific Reports Avoidance Extinction Fear conditioning Gut-brain axis Pain-related fear Visceral pain |
| title | Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear |
| title_full | Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear |
| title_fullStr | Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear |
| title_full_unstemmed | Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear |
| title_short | Costly pain avoidance and its impact on the modulation and extinction of visceral pain-related fear |
| title_sort | costly pain avoidance and its impact on the modulation and extinction of visceral pain related fear |
| topic | Avoidance Extinction Fear conditioning Gut-brain axis Pain-related fear Visceral pain |
| url | https://doi.org/10.1038/s41598-025-10499-9 |
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