Pain by mistake - Does a neural error processing signal predict avoidance behavior in pain?

Pain can be considered as a signal of “bodily error”: Errors – a wrong action that leads to a discrepancy between actual and optimal state – can put organisms at danger and activate behavioral defensive systems. If the error is of physical nature, pain is the warning signal that motivates protective action such as avoidance behavior to safeguard our body’s integrity. Hence, pain shares the functionality of errors. On the neural level, an important error processing component is the error-related negativity (ERN) which is implicated in learning and adjustment of behavior, including avoidance, and it is thought to reflect an individual’s threat sensitivity. Despite compelling evidence that the ERN plays an important role in various psychopathologies, its application in pain has not yet been examined. In the current project, we propose a relationship between neural error processing as reflected in the ERN and pain avoidance behavior, which we aim to systematically test in a series of studies in healthy participants and individuals with chronic pain. The arguments for such a relationship are based on anxiety literature and findings from broader ERN research, which we are currently integrating in a topical review. In a first study, we have tested whether elevated ERN amplitudes are associated with higher pain-related avoidance behavior using a novel robotic arm reaching paradigm. As a next step, this study will be replicated, with the addition of a more pain-relevant version of the ERN task which targets the processing of tactile rather than visual stimuli. Furthermore, the relationship between ERN and avoidance behavior is being investigated in a sample of patients with chronic low back pain in comparison to healthy individuals. In a final study, we are examining the role of threat and sensory modality with regard to error processing, as well as the relationship between ERN and avoidance, using a different avoidance measure. Results of this project will broaden our understanding of pain-related avoidance behavior and especially of its underlying neural mechanisms which are currently still poorly understood.