{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T22:46:03Z","timestamp":1785192363533,"version":"3.55.0"},"reference-count":43,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T00:00:00Z","timestamp":1592870400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Health and Medical Research Council of Australia"},{"name":"Vidi grant from the Netherlands Organization for Scientific Research (NWO), The Netherlands","award":["452-17-002"],"award-info":[{"award-number":["452-17-002"]}]},{"name":"Senior Research Fellowship of the Research Foundation Flanders (FWO-Vlaanderen), Belgium","award":["12E3717N"],"award-info":[{"award-number":["12E3717N"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Learning to predict threatening events enables an organism to engage in protective behavior and prevent harm. Failure to differentiate between cues that truly predict danger and those that do not, however, may lead to indiscriminate fear and avoidance behaviors, which in turn may contribute to disability in people with persistent pain. We aimed to test whether people with persistent neck pain exhibit contingency learning deficits in predicting pain relative to pain-free, gender-and age-matched controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We developed a differential predictive learning task with a neck pain-relevant scenario. During the acquisition phase, images displaying two distinct neck positions were presented and participants were asked to predict whether these neck positions would lead to pain in a fictive patient with persistent neck pain (see fictive patient scenario details in Appendix A). After participants gave their pain-expectancy judgment in the hypothetical scenario, the verbal outcome (PAIN or NO PAIN) was shown on the screen. One image (CS+) was followed by the outcome \u201cPAIN\u201d, while another image (CS\u2212) was followed by the outcome \u201cNO PAIN\u201d. During the generalization phase, novel but related images depicting neck positions along a continuum between the CS+ and CS\u2212 images (generalization stimuli; GSs) were introduced to assess the generalization of acquired predictive learning to the novel images; the GSs were always followed by the verbal outcome \u201cNOTES UNREADABLE\u201d to prevent extinction learning. Finally, an extinction phase was included in which all images were followed by \u201cNO PAIN\u201d assessing the persistence of pain-expectancy judgments following disconfirming information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Differential pain-expectancy learning was reduced in people with neck pain relative to controls, resulting from patients giving significantly lower pain-expectancy judgments for the CS+, and significantly higher pain-expectancy judgments for the CS\u2212. People with neck pain also demonstrated flatter generalization gradients relative to controls. No differences in extinction were noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The results support the hypothesis that people with persistent neck pain exhibit reduced differential pain-expectancy learning and flatter generalization gradients, reflecting deficits in predictive learning. Contrary to our hypothesis, no differences in extinction were found. These findings may be relevant to understanding behavioral aspects of chronic pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.9345","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T05:27:03Z","timestamp":1592890023000},"page":"e9345","source":"Crossref","is-referenced-by-count":8,"title":["Learning to predict pain: differences in people with persistent neck pain and pain-free controls"],"prefix":"10.7717","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7693-4158","authenticated-orcid":true,"given":"Daniel S.","family":"Harvie","sequence":"first","affiliation":[{"name":"The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia"},{"name":"School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen 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