title: Classical conditioning of analgesic and hyperalgesic pain responses without conscious awareness.
abstract: Pain reduction and enhancement can be produced by means of conditioning procedures, yet the role of awareness during the acquisition stage of classical conditioning is unknown. We used psychophysical measures to establish whether conditioned analgesic and hyperalgesic responses could be acquired by unseen (subliminally presented) stimuli. A 2 × 2 factorial design, including subliminal/supraliminal exposures of conditioning stimuli (CS) during acquisition/extinction, was used. Results showed significant analgesic and hyperalgesic responses (P < 0.001), and responses were independent of CS awareness, as subliminal/supraliminal cues during acquisition/extinction led to comparable outcomes. The effect was significantly larger for hyperalgesic than analgesic responses (P < 0.001). Results demonstrate that conscious awareness of the CS is not required during either acquisition or extinction of conditioned analgesia or hyperalgesia. Our results support the notion that nonconscious stimuli have a pervasive effect on human brain function and behavior and may affect learning of complex cognitive processes such as psychologically mediated analgesic and hyperalgesic responses.
authors.affiliation: Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17176 Stockholm, Sweden karin.jensen@ki.se.
authors.forename: Karin
authors.identifier: http://orcid.org/0000-0003-2521-3160
authors.initials: K
authors.lastname: Jensen
authors.affiliation: Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215;
authors.forename: Irving
authors.initials: I
authors.lastname: Kirsch
authors.affiliation: Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17176 Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Odmalm
authors.affiliation: Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215;
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Kaptchuk
authors.affiliation: Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17176 Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Ingvar
mesh_terms: D000698:Analgesia; D001364:Awareness; D003214:Conditioning, Classical; D006801:Humans; D006930:Hyperalgesia; D010146:Pain / Q000503:physiopathology*
keywords: awareness; classical conditioning; consciousness; nocebo; placebo