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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

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Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 18, Issue 3

Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality

Daniel S. Harvie
  • Corresponding author
  • The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Southport QLD 4222, Gold Coast, Australia, Phone: +61418826254
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Michele Sterling
  • Recover Injury Research Centre, NHMRC CRE in Recovery Following Road Traffic Injury, University of Queensland, Brisbane, Australia
  • Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ashley D. Smith
  • Recover Injury Research Centre, NHMRC CRE in Recovery Following Road Traffic Injury, University of Queensland, Brisbane, Australia
  • School of Allied Health Sciences, Griffith University, Gold Coast, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-04-30 | DOI: https://doi.org/10.1515/sjpain-2017-0165


Background and aims

Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain. This experiment aimed to determine whether contexts associated with pain, could modulate mechanical pain thresholds and pain intensity.


Forty-eight healthy participants underwent a contextual conditioning procedure, where three neutral virtual reality contexts were paired with either unpredictable noxious stimulation, unpredictable vibrotactile stimulation, or no stimulation. Following the conditioning procedure, mechanical pain thresholds and pain evoked by a test stimulus were examined in each context. In the test phase, the effect of expectancy was equalised across conditions by informing participants when thresholds and painful stimuli would be presented.


Contrary to our hypothesis, scenes that were associated with noxious stimulation did not increase mechanical sensitivity (p=0.08), or increase pain intensity (p=0.46). However, an interaction with sex highlighted the possibility that pain-associated contexts may alter pain sensitivity in females but not males (p=0.03).


Overall, our data does not support the idea that pain-associated contexts can alter pain sensitivity in healthy asymptomatic individuals. That an effect was shown in females highlights the possibility that some subgroups may be susceptible to such an effect, although the magnitude of the effect may lack real-world significance. If pain-associated cues prove to have a relevant pain augmenting effect, in some subgroups, procedures aimed at extinguishing pain-related associations may have therapeutic potential.

Keywords: pain; contextual conditioning; classical conditioning; conditioned hyperalgesia; pain mechanisms; nocebo; placebo


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About the article

Received: 2017-11-22

Revised: 2018-03-12

Accepted: 2018-03-18

Published Online: 2018-04-30

Published in Print: 2018-07-26

Authors’ statements

Research funding: Equipment utilised in this research was funded by the Physiotherapy Research Foundation, Griffith University, and the Sansom Institute for Health Research at the University of South Australia. Daniel S. Harvie is supported by the National Health and Medical Research Council (NHMRC), Australia (ID: 1142929).

Conflict of interest: The authors declare no conflicts of interest.

Informed consent: Informed consent was obtained from all participants.

Ethical approval: The study was approved by Griffith University Human Research Ethics (GU Ref No: 2016/242). No a priori protocol was registered.

Author contributions DSH, AS and MS developed the study concept, contributed to design, data interpretation, collection and write-up.

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 525–532, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2017-0165.

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