• Juliane Traxler, Diana M Torta, Andreas von Leupoldt, and VlaeyenJohan W SJWSResearch Group Health Psychology, KU Leuven, Leuven, Belgium; Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands..
• Research Group Health Psychology, KU Leuven, Leuven, Belgium; Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands. Electronic address: juliane.traxler@kuleuven.be.
• J Pain. 2022 Nov 1; 23 (11): 181118221811-1822.

AbstractErrors put organisms in danger. Upon error commission, error processing allows for the updating of behavior that proved ineffective in light of the current context and goals, and for the activation of behavioral defensive systems. Pain, on the other hand, signals actual or potential danger to one's physical integrity and, likewise, motivates protective behavior. These parallels suggest the existence of cross-links between pain and error processing but so far their relationship remains elusive. In this review, we tie together findings from the field of pain research with those from electroencephalography studies on error processing [specifically the Error Related Negativity (ERN) and Positivity (Pe)]. More precisely, we discuss 3 plausible associations: Firstly, pain may enhance error processing as it increases error salience. Secondly, persons fearful of pain may be particularly vigilant towards painful errors and thus show a stronger neural response to them. Thirdly, the ERN as a component of the neural response to error commission is considered an endophenotype of threat sensitivity. As high sensitivity to pain threats is known to incite avoidance behavior, this raises the intriguing possibility that neural signatures of error processing predict pain-related protective behaviors, such as avoidance. We propose an integration of these findings into a common framework to inspire future research. PERSPECTIVE: Inspired by research in anxiety disorders, we discuss the potential bi-directional relationships between error processing and pain, and identify future directions to examine the neural and psychological processes involved in acute and chronic pain and respective avoidance behavior.Copyright © 2022 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.

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