SUBJECTIVE-AFFECTIVE-COGNITIVE PROCESSES
The role of learning
Classical conditioning
Research suggests that classical conditioning may have an effect on the perception of
pain. As described by theories of associative learning, an individual may associate
a particular environment with the experience of pain. For example, if an individual
associates the dentist with pain due to past experience, the pain perception may be
enhanced when attending the dentist due to this expectation. In addition, because of the
association between these two factors, the individual may experience increased anxiety
when attending the dentist, which may also increase pain. Jamner and Tursky (1987)
examined the effect of presenting migraine sufferers with words associated with pain.
They found that this presentation increased both anxiety and pain perception and con-
cluded that the words caused a change in mood, which caused a change in the subject’s
perception of pain. This is further discussed in terms of the impact of anxiety.
Operant conditioning
Research suggests that there is also a role for operant conditioning in pain perception.
Individuals may respond to pain by showing pain behaviour (e.g. resting, grimacing,
limping, staying off work). Such pain behaviour may be positively reinforced (e.g. sym-
pathy, attention, time off work), which may itself increase pain perception (see below).
The role of affect
Anxiety
Some research has explored how patients worry about their pain. For example, Eccleston
et al. (2001) asked 34 male and female chronic pain patients to describe their experience
of pain over a seven-day period. The results showed that the patients reported both pain
related and non-pain related worry and that these two forms of worry were qualitatively
different. In particular, worry about chronic pain was seen as more difficult to dismiss,
more distracting, more attention grabbing, more intrusive, more distressing and less
pleasant than non pain related worry. Other research has explored how worry and
anxiety relate to pain perception. Fordyce and Steger (1979) examined the relationship
between anxiety and acute and chronic pain. They reported that anxiety has a different
relationship to these two types of pain. In terms of acute pain, pain increases anxiety, the
successful treatment for the pain then decreases the pain which subsequently decreases
the anxiety. This can then cause a further decrease in the pain. Therefore, because of the
relative ease with which acute pain can be treated, anxiety relates to this pain perception
in terms of a cycle of pain reduction. However, the pattern is different for chronic pain.
Because treatment has very little effect on chronic pain, this increases anxiety, which
can further increase pain. Therefore, in terms of the relationship between anxiety and
chronic pain, there is a cycle of pain increase. Research has also shown a direct
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