Do clinicians think that pain can be a classically conditioned response to a non-noxious stimulus?

Background: Anecdotally, clinical presentations in which pain seems to be elicited by non-noxious stimuli are often explained using a classical conditioning framework. We were primarily interested in whether (a) clinicians think that pain can be a classically conditioned response to a non-noxious stimulus, and (b) clinicians think that there is evidence to support that idea.

Method: Practising healthcare clinicians participated anonymously in an online survey. The information collected included descriptive demographics, clinical experience, personal experience of chronic pain, beliefs about pain, and beliefs about classical conditioning and pain. Responses to the pre-requisite question - whether pain can occur without nociception - were compared to a historical data set from 2004.

Results: 1090 people from 57 countries and eight distinct types of health profession completed the survey. 86% stated that pain can occur without nociception; 96% of those believed that pain can be a classically conditioned response to a non-noxious stimulus; 98% of those believed that there is evidence to support that statement. The 2004 data showed that 44% of participants distinguished between pain and nociception.

Conclusions: This broad sample overwhelmingly endorsed the ideas that clinicians think that pain can be a classically conditioned response to a non-noxious stimulus and think that there is evidence to support that idea, revealing a discrepancy between beliefs in the clinical community and the scientific evidence. The distinction between nociception and pain has become more accepted by the clinical community over the last 10 years.