Pain increases motivational drive to obtain reward, but does not affect associated hedonic responses: a behavioural study in healthy volunteers

Background: Pain and reward have been suggested to interact, and some evidence is provided by a rodent study showing that acutely injured animals are more motivated to reach a food reward while they do not increase food consumption, pointing at unaltered reward liking. Since no data exist in humans, we conducted a psychophysical experiment to test the effects of experimentally induced tonic pain on (1) the motivation to receive reward and (2) hedonic responses when being rewarded.

Methods: Forty healthy participants underwent two experimental sessions: in one, painful heat stimulation was continuously applied while participants played a monetary reward task; in the other, participants experienced non-painful warm stimulation while playing the task. In the task, participants needed to react quickly enough to a target cue to win the money associated with the particular trial ($0.04, $1 or $4). Reaction time to the target cue served as measure of motivation. Ratings after each trial on how much the participant liked the trial's outcome served as a measure of hedonic responses.

Results: Pain increased the motivation to obtain reward when the incentive was high, indexed by decreased reaction times (repeated-measures analysis of variance, interaction pain × incentive; p = 0.009). In contrast to motivational drive, hedonic ratings of the rewarding stimuli were not influenced by pain.

Conclusion: Similar to existing rodent data, our results suggest a pain-induced mismatch of increased motivational drive with a lack of increased hedonic responses. This mismatch is discussed as perhaps reflecting a failed coping attempt, which is potentially relevant for chronic pain patients.