Habituation, sensitization, and emotional valence modulation of pain responses

The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-charged pictures during which painful stimuli are delivered. Across several ECON studies, unpleasant pictures enhanced pain and nociception, whereas pleasant pictures inhibited pain and nociception. However, at this time it is unknown whether emotional valence (unpleasant, neutral, pleasant) influences the habituation or sensitization of pain responses that occurs within a testing session. Indeed, ECON assumes that emotional valence modulation of pain is consistent throughout testing; otherwise the interpretation of valence modulation (unpleasant > neutral > pleasant) could be threatened. To address this issue, the present study (N = 120) presented 108 pictures that varied in emotional valence. During and in between pictures, 52 suprathreshold electrocutaneous stimuli were delivered to evoke pain, the nociceptive flexion re. ex [NFR], and pain-evoked skin conductance response [SCR]. Mixed effects ANOVAs verified that within-subject changes in pain responses were influenced by stimulus repetition (NFR and SCR habituated, pain ratings sensitized) and emotional valence (responses were highest during unpleasant pictures, intermediate during neutral pictures, and lowest during pleasant pictures). However, habituation/sensitization slopes were unaffected by emotional valence, thus indicating emotional valence modulation was consistently observed throughout the testing session. These results provide additional validation for the ECON paradigm and suggest that the circuit responsible for emotional modulation of pain and nociception is less susceptible to habituation or sensitization than the circuits responsible for responses to suprathreshold shocks. (C) 2009 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.