Solving the exploration-exploitation dilemma in a dynamic pain-related context: The benefits of exploratory behaviors

Daily decision-making involves navigating the explore-exploit dilemma (EED), balancing novel information gathering against maintaining current strategies. Individuals with chronic pain often exhibit exploitation responses, choosing pain avoidance over exploring potentially beneficial activities. This study investigated decision-making during the EED in individuals with chronic pain and pain-free individuals, examining whether self-initiated exploration predicts improved outcomes when environmental contingencies change. Participants completed a multi-armed bandit task where contingency changes occurred exclusively for unchosen options, requiring active exploration for discovery. We assessed behavioral performance, computational modeling parameters, and individual difference variables including fear of pain, intolerance of uncertainty, and behavioral activation/inhibition. Initial high exploration rates predicted superior task performance across all groups, despite few participants discovering the contingency change. Contrary to our original hypotheses, no consistent differences emerged between the pain-free and pain groups. However, differences between the pain groups suggested that greater pain severity may be associated with less stable and less exploitative decision-making. These findings highlight the importance of an adaptive balance between exploration and exploitation for discovering environmental changes and achieving optimal long-term outcomes, supporting its role in avoidance extinction relevant to chronic pain treatment.