Competing Goals Attenuate Avoidance Behavior in the Context of Pain

• Motivational aspects impact pain-related outcomes in healthy subjects.
• Introducing a competing, approach-reward does not impact pain-related fear.
• Presenting a competing, approach-reward goal attenuates avoidance behavior.
• Avoidance behavior is associated with both pain-avoidance and approach-reward goals.

Current fear-avoidance models consider pain-related fear as a crucial factor in the development of chronic pain. However, pain-related fear often occurs in a context of multiple, competing goals. This study investigated whether pain-related fear and avoidance behavior are attenuated when individuals are faced with a pain avoidance goal and another valued but competing goal, operationalized as obtaining a monetary reward. Fifty-five healthy participants moved a joystick toward different targets. In the experimental condition, a movement to one target (conditioned stimulus [CS+]) was followed by a painful unconditioned stimulus (pain-US) and a rewarding unconditioned stimulus (reward-US) on 50% of the trials, whereas the other movement (nonreinforced conditioned stimulus [CS−]) movement was not. In the control condition, the CS+ movement was followed by the pain-US only. Results showed that pain-related fear was elevated in response to the CS+ compared to the CS− movement, but that it was not influenced by the reward-US. Interestingly, participants initiated a CS+ movement slower than a CS− movement in the control condition but not in the experimental condition. Also, in choice trials, participants performed the CS+ movement more frequently in the experimental than in the control condition. These results suggest that the presence of a valued competing goal can attenuate avoidance behavior.PerspectiveThe current study provides experimental evidence that both pain and competing goals impact on behavioral decision making and avoidance behavior. These results provide experimental support for treatments of chronic pain that include an individual's pursuit of valuable daily life goals, rather than limiting focus to pain reduction only.