Nocebo Hyperalgesia Induced by Social Observational Learning

Nocebo effects can be acquired by verbal suggestion, but it is unknown whether they can be induced through observational learning and whether they are influenced by factors known to influence pain perception, such as pain anxiety or pain catastrophizing. Eighty-five female students (aged 22.5 ± 4.4 years) were randomly assigned to one of three conditions. Participants in the control condition (CC) received information that an ointment had no effect on pain perception. Participants in the verbal suggestion condition (VSC) received information that it increased pain sensitivity. Participants in the social observational learning condition (OLC) watched a video in which a model displayed more pain when ointment was applied. Subsequently, all participants received three pressure pain stimuli (60 seconds) on each hand. On one hand, the ointment was applied prior to the stimulation. Numerical pain ratings were collected at 20-second intervals during pain stimulation. The participants filled in questionnaires regarding pain-related attitudes (Pain Anxiety Symptoms Scale, Pain Catastrophizing Scale, and Somatosensory Amplification Scale). Participants in the OLC showed higher pain ratings with than without ointment. Pain ratings within the CC and the VSC were at the same level with and without ointment. In the VSC, the pain ratings were higher than in the CC with and without ointment. The nocebo response correlated with pain catastrophizing but not with pain anxiety or somatosensory amplification. A nocebo response to pressure pain was induced by observational learning but not by verbal suggestion. This finding highlights the importance of investigating the influence of observational learning on nocebo hyperalgesia.