707: Are Pain-Avoidance Decisions in Virtual Reality Supported by Motor Preparation in the Brain?

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Psychology, Electrophysiology/Clinical neurophysiology (e.g. microneurography, EEG, MEG, OPMs, TMS)

Background and Aims: Pain facilitates defensive responses aimed at preventing further bodily harm, often by avoiding potentially painful actions. Although avoidance behaviour has been extensively studied, the contribution of motor preparation processes in the brain to pain-related avoidance is poorly understood. This study investigated motor preparation in a virtual reality (VR) motor choice task in which movements to one side resulted in experimentally induced pain and movements to the other side not. We hypothesized that avoidance (i.e., choosing movements not resulting in pain) would be associated with stronger motor preparatory activity in the brain.

Methods: 73 healthy subjects performed a VR motor task in which goal-directed movements were either or not followed by painful stimuli. Participants executed arm-reaching movements, placing virtual objects in a left or right bin, and learned that probability of pain was higher for movements towards one side. They were instructed to choose the left or right movement based on object colour, which was clear (blue vs. red) or ambiguous (mix of blue and red). Amplitudes of early and late Contingent Negative Variation (CNV) components, assessed by electroencephalography, served as neurophysiological markers of motor preparation, and were analysed using linear mixed-effect models.

Results: In ambiguous trials there was a decreased likelihood of moving toward the side more frequently paired with pain (β = -0.290, z = -3.01, p = 0.003), indicating behavioural avoidance. Avoidance decisions were not associated with changes in early CNV (β = -0.335, t = -0.19, p = 0.845) or late CNV amplitude (β = 2.251, t = 1.00, p = 0.317). However, a simplified model, which excluded movement direction, revealed a stronger early CNV amplitude in ambiguous trials (β = -1.176, t = -2.07, p = 0.039).

Conclusions: Our findings showed that, when instruction is ambiguous, there is a preference to avoid movements with a higher chance of pain. However, no direct link between pain-related avoidance decisions and motor preparation processes could be found. Nonetheless, the overall increase of early motor preparatory activity in ambiguous trials may reflect heightened cortical involvement in deciding whether to approach or avoid potential pain.

References: Babiloni, C., Arendt-Nielsen, L., Pascual-Marqui, R. D., Rossini, P. M., Brancucci, A., Del Percio, C., Babiloni, F., Sabbatini, G., & Chen, A. C. N. (2004). Cortical sensorimotor interactions during the expectancy of a Go/No-Go task: Effects of painful stimuli. Behavioral Neuroscience, 118(5), 925–935. https://doi.org/10.1037/0735-7044.118.5.925

Klein, P. A., Olivier, E., & Duque, J. (2012). Influence of reward on corticospinal excitability during movement preparation. Journal of Neuroscience, 32(50), 18124–18136. https://doi.org/10.1523/JNEUROSCI.1701-12.2012

Schouppe, S., Clauwaert, A., Van Oosterwijck, J., Van Damme, S., Palmans, T., Wiersema, J. R., Sanchis-Sanchéz, E., & Danneels, L. (2020). Does experimentally induced pain-related fear influence central and peripheral movement preparation in healthy people and patients with low back pain? Pain, 161(6), 1212–1226. https://doi.org/10.1097/j.pain.0000000000001813

Presenting Author: Lou Meert
Submitting Author: Lou Meert

Senior Author: Prof. Stefaan Van Damme

IASP 2026 Global Year theme of Neuropathic Pain: No

• Eleana Pinto: PhD - Ghent University
• Prof. Dimitri Van Ryckeghem: PhD - Maastricht University
• Prof. Stefaan Van Damme: PhD - Ghent University