Chapter 8 – General discussion 259 induction and persistence, is discussed in relation to gaps in the literature and our general understanding of negativity bias and emotional memory. We further discuss the limitations of this work and of this model-based scientific field as a whole, and we propose future directions in nocebo research and for clinical practice. We conclude that nocebo hyperalgesia decidedly influences pain, and that such learned effects rely on the brain’s tendency to learn, adapt, and integrate cognitive and emotional information, especially in relation to prior negative experiences. General discussion Nocebo hyperalgesia has been researched as a negative pain outcome for over three decades. The work on reviewing this literature, conducted as part of this PhD project, resynthesized current knowledge and investigated common themes such as the central role of behavioral conditioning, as well as a focus of the field on emotions such as anxiety and stress. In the sections that follow, we start by discussing lessons from the literature and the impact of methodological focus in understanding nocebo hyperalgesia. Next, we discuss this project in relation to the overarching concepts and wider implications of two central conclusions derived from our findings. First, we identify cognitive mechanisms under the umbrella of associative learning, beyond the more general established correlate of associative learning. Second, we discuss a potential cooperation of cognitive and fear-specific learning mechanisms. Limitations in the research are addressed and theoretical considerations as well as future directions for the field are also discussed.
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