Does Pain Affect Preference? The Effect of Tonic Laboratory Pain on Discounting of Delayed Rewards

Chronic pain patients show elevated risk behavior on decision-making tasks, as well as increased health risk behaviors (eg, smoking, prescription opioid abuse). Determining pain's effect on underlying cognitive processes that are associated with risk behavior is confounded by comorbidities linked with chronic pain, including depression, anxiety, and substance abuse. Therefore, to understand pain's effect on delay discounting, a behavioral process assessing the extent to which outcomes are devalued as a function of their delay, the present study evaluated the effect of laboratory pain on delay discounting in healthy young adults (N = 85). Using a mixed factorial design, pain (topical capsaicin and warmth) as well as active control (warmth) groups completed a delay discounting task before and during exposure to their respective manipulations. Whereas the pain condition had no effect on delay discounting, participants' pain intensity, unpleasantness, and pain-induced negative valence were associated with less discounting of delayed rewards. However, the effects were very small. Perspective: The results suggest that experimental pain may not increase delay discounting, rather sensitivity to pain predicts a very small decrease in discounting of delayed rewards. Although the results are limited to healthy volunteers, this experimental approach allows us to examine the relationship between pain and delay discounting in a controlled manner. Better understanding of pain-related decision-making may lead to improved treatment of health risk behaviors for individuals experiencing pain.