Pain-related learning mechanisms likely play a key role in the development and maintenance of chronic pain. Previous smaller-scale studies have suggested impaired pain-related learning in patients with chronic pain, but results are mixed, and chronic back pain (CBP) particularly has been poorly studied. In a differential conditioning paradigm with painful heat as unconditioned stimuli, we examined pain-related acquisition and extinction learning in 62 patients with CBP and 61 pain-free healthy male and female volunteers using valence and contingency ratings and skin conductance responses. Valence ratings indicate significantly reduced threat and safety learning in patients with CBP, whereas no significant differences were observed in contingency awareness and physiological responding. Moreover, threat learning in this group was more impaired the longer patients had been in pain. State anxiety was linked to increased safety learning in healthy volunteers but enhanced threat learning in the patient group. Our findings corroborate previous evidence of altered pain-related threat and safety learning in patients with chronic pain. Longitudinal studies exploring pain-related learning in (sub)acute and chronic pain are needed to further unravel the role of aberrant pain-related learning in the development and maintenance of chronic pain.

疼痛相关的学习机制可能在慢性疼痛的发展和维持中发挥关键作用。之前的小规模研究表明，慢性疼痛患者的疼痛相关学习能力受损，但结果好坏参半，尤其是对慢性背痛 (CBP) 的研究很少。在以疼痛热作为无条件刺激的差异调节范式中，我们使用效价和应急评级以及皮肤电导反应，检查了 62 名 CBP 患者和 61 名无痛健康男性和女性志愿者的疼痛相关获得和消退学习。效价评级表明 CBP 患者的威胁和安全学习显着降低，而在应急意识和生理反应方面没有观察到显着差异。此外，患者承受疼痛的时间越长，该组的威胁学习能力就越弱。状态焦虑与健康志愿者的安全学习增加有关，但与患者组的威胁学习增加有关。我们的研究结果证实了先前的证据，即慢性疼痛患者的疼痛相关威胁和安全学习发生了变化。需要进行探索（亚）急性和慢性疼痛中疼痛相关学习的纵向研究，以进一步揭示异常疼痛相关学习在慢性疼痛的发展和维持中的作用。