Affective Predictions in Chronic Pain: Differential Associations With Pain Interference and Intensity

Expectations have an important impact on emotion-pain interactions. Previous studies have primarily focused on the influence of pain-related expectations on perceived pain intensity. However, expectations regarding negative-valence information more broadly may impact perception beyond pain and be altered when pain becomes chronic. The current study aimed to investigate whether patients with chronic pain exhibit alterations in social-emotional expectations beyond pain perception.

Thirty-five adults with chronic pain, recruited at the Pain Unit of Hospital del Mar in Barcelona (three excluded prior to analysis; final n = 32) and 35 age- and gender-matched healthy controls performed a social perception task designed to elicit expectations about facial expressions and assess their impact on social evaluation. Facial expressions were either stereotypically congruent with the evoked emotion (matched trials) or stereotypically associated with a different emotion category (non-matched trials). Expectations (predictability ratings) and social evaluation (likability ratings) were measured.

Selective alterations were observed for pain interference and intensity. Pain interference was associated with reduced differentiation of predictability ratings between matched and non-matched trials, suggesting less stereotypical emotion expectations. In contrast, pain intensity (and chronic pain condition itself) was associated with a stronger relationship between predictability and likability ratings, suggesting a greater reliance on predictability during social evaluation.

Our findings suggest that chronic pain may be associated with alterations in social-emotional expectations and in their relationship with social evaluation, potentially influencing not only pain perception but also affective and interpersonal functioning.

This study suggests that chronic pain is associated with alterations in social-emotional expectations beyond nociception. Individuals with chronic pain showed a stronger relationship between predictability and likability ratings. In contrast, higher pain interference was associated with smaller differences in predictability ratings between stereotypically matched and non-matched emotional cues. These associations may help illuminate cognitive-emotional factors linked to the emotional and interpersonal difficulties commonly observed in chronic pain.