Generalization of Costly Pain-Related Avoidance Based on Real-Life Categorical Knowledge

Avoiding activities posing bodily threat is adaptive. However, spreading of avoidance to safe activities may cause functional disability in people with chronic pain. We investigated whether costly pain-related avoidance would generalize from one activity to another on the basis of real-life categorical knowledge in 40 pain-free people (30 female; mean age = 25 years; university students and public of Maastricht, The Netherlands). In a computer task, participants moved a joystick to complete activities from two categories (gardening and cleaning). During activities from the avoidance category, pain could be avoided at the cost of task efficiency by deviating from a short, pain-associated joystick movement. Activities from the safe category were never painful. Subsequently, we tested generalization of avoidance to novel pain-free activities from both categories. Participants generalized avoidance to novel activities from the avoidance category despite the novel activities not being paired with pain and despite avoidance costs, suggesting that costly (pain-related) avoidance generalizes from one activity to another on the basis of category knowledge and can thus be wide reaching, creating detrimental consequences.