The role of kinesthetic and visuospatial cues in pain-related movement avoidance

When humans experience pain during a movement, they can develop fear and avoid this movement afterward; these responses likely play a role in chronic pain. Previous experiments have investigated the underlying learning mechanisms by pairing movements with painful stimuli but, usually, other visuospatial cues were concurrently presented during the learning context. Therefore, participants might have primarily avoided these visuospatial rather than the movement-related cues, potentially invalidating related interpretations of pain-induced movement avoidance. Here, we separated kinesthetic from visuospatial cues to investigate their respective contribution to avoidance. Participants used a hand-held robotic manipulandum and, during an acquisition phase, received painful stimuli during center-out movements. Pain stimuli could be avoided by choosing curved rather than direct movement trajectories. To distinguish the contribution of kinesthetic versus visuospatial cues we tested two generalization contexts: either participants executed novel movements that passed through the same location at which pain had previously been presented in the acquisition phase; or they were reseated and then executed identical movements as those that had been associated with pain, but without passing through the pain-associated spatial location. Avoidance generalization was comparable in both contexts, and remarkably, highly correlated between them. Our findings suggest that both visuospatial and kinesthetic cues available during acquisition were associated with pain and led to avoidance. Our research corroborates previous studies' findings that pain can become associated with movements. However, visuospatial cues also play a critical role for avoidance acquisition. Future studies should distinguish movement-related and space-related associations in pain-related avoidance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).