Defence response mobilization via interoceptive sensations in children with chronic pain

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Chronic pain disorders in children are highly disabling and a significant health problem with prevalence rates of three to five percent. Exposure to severe and uncontrollable acute pain can be a terrifying experience, which activates an immediate defensive reaction according to the Threat Imminence Model, comprising of increases in autonomic arousal and the urge to escape. In children with chronic pain disorders, interoceptive sensations that accompany the pain experience may become conditioned stimuli that elicit conditioned defensive responses, leading to aggravated pain, disability, and anxious apprehension followed by avoidance behaviour. Increasing research evidence underlines the importance of interoceptive processes, especially in the aetiology of headache and functional abdominal pain, the predominant pain problems in children. However, direct evidence for defensive responses following interoceptive sensations is lacking in chronic pain research in children and adults. The proposed research program will close two gaps of current international research: First, we will study whether the perceptions of benign interoceptive sensations can elicit defence response mobilization in children and adolescents (11 to 18 years) with chronic daily headache (CDH; n=40), functional abdominal pain (FAP; n=40) and healthy children (HC, n=40). Two types of cues will be used: cues that are locally proximal vs. locally distal to the main pain. Based on the proximity hypothesis, it is hypothesized that stimuli from the same body region (proximal) are more likely to evoke defence response mobilization than stimuli from distal body regions. Second, we will investigate whether disorder-specific aversive imagery of interoceptive sensations can also elicit defence response mobilization. This will be studied in a second experiment with 26 children and adolescents (11-18 years) with chronic pain disorders. It is hypothesized that aversive imageries are more likely to evoke defence response mobilization than neutral imageries. In both studies, defence response mobilization will be studied using a well-established instructed fear paradigm. Childrens response will be measured using a state of the art multimodal assessment approach consisting of self-report, peripheral physiological reactivity, including skin conductance level, heart rate and startle potentiation.The present project will be the first to investigate defence response mobilization triggered via perceived and imagined interoceptive sensations in children with chronic pain disorders and will make a salient contribution to the still scant field of experimental research in clinical child and adolescent pain. The results of the study will not only add important knowledge to the aetiology and maintenance of chronic pain in children, but will also provide the basis for the development of new treatment interventions, such as interoceptive imaginal exposure to decrease the defence response mobilization.