This pre-registered study compared approach-avoidance biases and Pavlovian behavioural suppression in chronic pain patients vs. healthy controls, using an approach-avoidance task (pain-related, medication-related, and neutral images) and a cued go/no-go Pavlovian Bias task with monetary rewards and punishments.
Chronic pain patients showed an exaggerated approach bias toward medication-related images (without rating them as more pleasant) and increased behavioural suppression under monetary loss cues, but — contrary to hypothesis — did not show greater active avoidance of pain-related images compared to controls.
- Small sample size; authors explicitly call for replication in larger groups. - Cross-sectional design limits causal inference about whether biases precede or follow chronic pain. - Monetary loss cues used as a proxy for threat; ecological validity to real-world pain avoidance is uncertain.
Behavioural suppression — not just active avoidance — may be a clinically relevant target in chronic pain; clinicians should consider that patients may be prone to motivational 'freezing' under threat cues, which could undermine engagement with activity-based treatments.
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