People experiencing pain try to make sense of their experience to gain control of the pain experience and its impact on their life. In order to make sense of their experience, patients form a cognitive representation of their symptoms that undergoes predictive processing in the brain. Predictive processing relies on previously acquired beliefs and experiences that include:

• the identity of the symptom

• the cause of the symptom

• the consequences of the symptom

• the controllability of the symptom

• the timeline of the symptom

During predictive processing, the brain makes active predictions as to the causes and the nature of incoming sensory signals and compares these predictions to the actual input. Discrepancies between predictions and actual inputs, predictions errors, are used to update this cognitive process allowing the body to adapt and learn from new contexts and responses. This plasticity of the brain can be used therapeutically to update the prediction models of the brain, potentially changing a patient pain cognition and behavior.

A recent study by Kube et al. strengthens the predictive model of pain perception. The study shows that pain perception is influenced by patients’ expectations. Indeed, participants who expected a decrease in pain reported a greater reduction of pain intensity than participants who believed that pain would increase. Furthermore, the expectation of decreasing pain shaped perceived pain intensity in the direction of the expectation, and the perception of decreasing pain lowered future pain expectations accordingly. Challenging patients’ expectations (expectation violation) is positively correlated with change in pain tolerance and the ability to cope with normal pain. Thus, experiencing a large expectation violation was associated with increased pain tolerance and more confidence in the ability to cope with normal pain in daily live.

Clinicians involved in the management of MSK disorders, need to understand and assess contextual factors at play in patients’ experience of symptoms to care for them.

References

Kube, T., Körfer, K., Riecke, J., & Glombiewski, J. (2022). How expectancy violations facilitate learning to cope with pain – An experimental approach. Journal Of Psychosomatic Research, 157, 110807. doi: 10.1016/j.jpsychores.2022.110807

VIANIN, M. (2021). DISPOSITIONALISM IN MUSCULOSKELETAL CARE. [S.l.]: EVOLVE GLOBAL PUBLISHING. https://mskcarethebook.com/index#

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