Fear Learning In Adolescents With Chronic Pain: Neural And Behavioral Mechanisms

Fear is a particularly salient influence on pain outcomes and is the focus of the current research proposal. Asignificant proportion of youth with chronic pain endorse elevated pain-related fear. Pain-related fear isassociated with high levels of disability, depressive symptoms, and school impairment. Beyond the individual,contextual influences substantially impact fear learning. Parents are profoundly affected when their childexperiences pain and their (mal) adaptive response impacts outcomes. Thus, defining adolescent fear learningin chronic pain must incorporate parent distress and behavior. In the context of treatment, decreasing painrelatedfear is associated with improved physical and psychological functioning, while high initial pain-relatedfear is a risk factor for less treatment responsiveness. Although it is recognized that high levels of pain-relatedfear can be detrimental, the neurobiological mechanisms for acquisition and extinction of fear have yet to bedefined in pain patients. This is particularly germane during adolescence where neuronal properties are primedfor modification by experience and the peak onset of chronic pain in childhood occurs. Moreover, extinction,the primary means of eradicating fear, is not consistently effective as fear may return when in a new context orunder stress. Thus, more robust techniques are needed to diminish fear in a context-independent fashion. Onemethod to prevent the return of fear is disruption of fear memory reconsolidation, where extinction occurs in atime window during which the fear memory is labile. This method, established in rodents and humans, has yetto be demonstrated in pediatric pain patients. This proposal investigates the mechanisms underlying fearlearning, fear extinction, and disruption of fear reconsolidation in adolescents with chronic pain and healthycontrols using behavioral and neuroimaging measures with the long-term goal of improving exposure-basedtreatments for adolescents with chronic pain. Aim 1 examines acquisition and extinction of fear learningbehaviorally and neurobiologically in adolescents with chronic pain and low or high pain-related fear andhealthy controls with consideration of the influence of parent fear and avoidance behavior. Aim 2 examinesenhancement of fear extinction with disruption of fear memory reconsolidation. Currently, the treatment ofchronic pain is suboptimal. Significant breakthroughs require a mechanistic understanding of key processesunderlying pain-related dysfunction.