Perception of repeated pain relief with controllable and uncontrollable pain

Background
The ultimate goal of pain research is to provide effective routes for pain relief. Nevertheless, the perception pain relief as a change in pain intensity and un‐/pleasantness has only been rarely investigated. It has been demonstrated that pain relief has rewarding and reinforcing properties, but it remains unknown whether the perception of pain relief changes when pain reductions occur repeatedly. Further, it remains an open question whether the perception of pain relief depends on the controllability of the preceding pain.

Methods
In this study, healthy volunteers (N = 38) received five cycles of painful heat stimulation and reduction of this stimulation to a non‐painful warm stimulation once in a condition with control of the stimulation and once without control. Participants rated perceived intensity and un‐/pleasantness on visual analogue scales during the heat stimulation and immediately after its reduction.

Results
Results showed that perceived pain relief, estimated by the difference in ratings during ongoing heat stimulation and after its reduction, increased with repetitions. However, this increase levelled off after two to four repetitions. ... mehrFurther, perceived pain relief was larger in the condition without control compared to the condition with control.

Conclusion
The perception of pain relief can be modulated similar to the perception of pain by stimulus characteristics and psychological factors. Mechanistic knowledge about such modulating factors is important, because they can determine, e.g., the amount of requested pain killers in clinical settings and the efficacy of pain relief as a reinforcing stimulus.

Significance
When in pain, pain relief can become an all‐dominate goal. The perception of such pain relief can vary depending on external and internal characteristics and thus modulate, e.g., requests for pain killers in clinical settings. Here, we show that perceived intensity and pleasantness of pain relief changes with repetitions and whether the preceding pain is perceived as uncontrollable. Such mechanistic knowledge needs to be considered to maximize the effects of pain relief as a rewarding and reinforcing stimulus.