BEHAVIORAL NEUROSCIENCE OF PAIN AVOIDANCE : COGNITIVE AND MOTIVATIONAL BIASES UNDERMINING PAIN CONTROLLABILITY

疼痛表明我们的身体完整性受到了紧急威胁；它要求我们全神贯注，并要求立即采取行动。然而，痛苦也标志着我们在漫长的决策链中犯了一个错误，最终导致我们将自己暴露在危险之中。因此，痛苦也迫使我们重新评估我们未来的行动计划。因此，疼痛的影响远远超出了眼前的痛苦经历：基于过去痛苦经历的对未来痛苦的预期会影响我们当前的决定、情绪和疼痛敏感性。因此，从行为控制系统的角度来看，持续的无法控制的疼痛是人们可能面临的最糟糕的情况。不幸的是，这正是数百万慢性疼痛患者每天面临的挑战。遗憾的是，我们仍然缺乏疼痛行为效应背后的神经生理机制的基本知识，因为迄今为止，对人类的研究主要集中在疼痛刺激的直接体验特性上（即疼痛的感觉）。因此，拟议的研究计划的目标将是确定潜在的认知和动机偏见的大脑机制，这些偏见可能会破坏对疼痛的成功控制。*******拟议的研究计划包括三个研究，每个研究包括脑电图（EEG）和功能磁共振成像（fMRI）实验。这两种技术的结合将使我们能够检查大脑对疼痛反应的精确空间和时间特征及其作为可控性功能的预期。更具体地说，研究1将检查一段时间无法控制的疼痛之后的器质性学习缺陷。这种现象被称为“习得性无助”，通常会导致人们停止试图控制疼痛，即使他们有可能学会控制疼痛。研究2将检查风险和模糊厌恶偏见，即认知偏见，使我们高估痛苦的风险，往往导致不利的决定。最后，研究3将调查确认偏差，这使得很难了解疼痛可能没有我们预期的那么高。总之，这些研究将进一步加深我们对认知和动机偏见的大脑机制的理解，这些偏见会损害对疼痛的行为控制，这是一个与数百万每天患有慢性疼痛的加拿大人高度相关的话题

Pain signals the presence of an urgent threat to our corporal integrity; it calls for our complete attention and commands immediate action. However, pain also marks an error in the long chain of decisions that ultimately led us to expose ourselves to danger. Pain therefore also compels us to reassess our future action plans. The effects of pain thus resonate far beyond the immediate painful experience: anticipation of future pain based on past painful experiences influences our current decisions, mood, and pain sensitivity. Hence, from the standpoint of behavioral control systems, unremitting uncontrollable pain is the worst possible scenario one can be confronted with. Unfortunately, this is the challenge that millions of patients with chronic pain are facing every day. Alas, we are still lacking basic knowledge of the neurophysiological mechanisms underlying pain's behavioral effects, as research in humans has so far predominantly focused on the immediate experiential properties of painful stimulations (i.e., how pain feels). The objective of the proposed research program will therefore be to identify the cerebral mechanisms underlying cognitive and motivational biases that can undermine successful control over pain.*******The proposed research program encompasses three studies, each comprising an electroencephalography (EEG) and a functional magnetic resonance imaging (fMRI) experiment. The combination of these two techniques will allow us to examine the precise spatial and temporal characteristics of the cerebral responses to pain and its anticipation as a function of controllability. More specifically, study 1 will examine the instrumental learning deficits that follow from a period of uncontrollable pain. This phenomenon, called “learned helplessness”, often leads people to stop trying to control the pain even when they could possibly learn to control it. Study 2 will examine risk and ambiguity aversion biases, i.e. cognitive biases that bring us to overestimate the risk of pain and often lead to disadvantageous decisions. Finally, study 3 will investigate confirmation biases that makes it difficult to learn that pain may not be as high as we expected. Altogether, these studies will further our understanding of the cerebral mechanisms underlying cognitive and motivational biases that can impair behavioral control over pain, a topic which is highly relevant for the millions of Canadians living with chronic pain every day.**