The role of prior pain experience and expectancy in psychologically and physically induced pain

Cognitive theories regarding symptom formation suggest that environmental factors such as warnings of impending pain and earlier experiences with pain can lead to a cognitive schema in which pain is selectively monitored. This study evaluated the role of prior experience with pain in the development of expectancy induced somatoform pain. Subjects from two experimental groups were connected to a sham stimulator and told to expect a headache. One of these groups, the physical stimulation first group, was exposed to pain induction by ice water and by pressure prior to the sham stimulation. A second group, the sham stimulation first group, received the sham stimulation followed by the cold water and pressure pain induction techniques. Subjects in the physical stimulation first group showed significant increases in their pain reports as settings on the sham stimulator were increased. Significant increases were not noted in the sham stimulation first group. The two groups did not differ in the number of subjects reporting pain or the mean maximal pain reported during the sham stimulation. Duration of cold water tolerance and the time until the analgesic threshold level for cold water were significantly shorter in subjects who had the sham stimulation first. This study suggests that prior pain can influence the reactivity to external suggestion for pain but does not increase the frequency of pain reports. It does suggest that the selective monitoring induced during the sham stimulation may influence later pain behaviours as was seen during the cold water tolerance testing.