Do clinicians think that pain can be a classically conditioned response to a non-noxious stimulus?

• An international online survey of healthcare clinicians from varied professions.
• 96% of surveyed clinicians think pain can be evoked via classical conditioning.
• 98% of those clinicians are unaware that that view is not supported by evidence.
• Mechanistic research is a priority to inform clinical reasoning about pain.
• Clinicians' basic pain knowledge has improved since 2004.

BackgroundAnecdotally, clinical presentations in which pain seems to be elicited by non-noxious stimuli are often explained using a classical conditioning framework. We were primarily interested in whether (a) clinicians think that pain can be a classically conditioned response to a non-noxious stimulus, and (b) clinicians think that there is evidence to support that idea.MethodPractising healthcare clinicians participated anonymously in an online survey. The information collected included descriptive demographics, clinical experience, personal experience of chronic pain, beliefs about pain, and beliefs about classical conditioning and pain. Responses to the pre-requisite question – whether pain can occur without nociception – were compared to a historical data set from 2004.Results1090 people from 57 countries and eight distinct types of health profession completed the survey. 86% stated that pain can occur without nociception; 96% of those believed that pain can be a classically conditioned response to a non-noxious stimulus; 98% of those believed that there is evidence to support that statement. The 2004 data showed that 44% of participants distinguished between pain and nociception.ConclusionsThis broad sample overwhelmingly endorsed the ideas that clinicians think that pain can be a classically conditioned response to a non-noxious stimulus and think that there is evidence to support that idea, revealing a discrepancy between beliefs in the clinical community and the scientific evidence. The distinction between nociception and pain has become more accepted by the clinical community over the last 10 years.