INTRODUCTION Common cerebral processes, involved in both emotion and pain, suggest that the experience of pain is always modulated to some extent by co-existing emotions (Melzack and Wall, 1965; Robinson and Riley, 1999). Because of this, it might not always be clear how both constructs relate to each other. Some studies support the hypothesis that negative emotion is a frequent psychological reaction to pain, i.e. emotional distress is a consequence of both acute and chro- nic pain (Craig, 1994; Gamsa, 1990). This study focuses on mechanisms by which emotions may instigate or increase pain. Although there is no empirical support for the proposition that emotional distress really causes pain (Gamsa, 1994), there is sufficient evidence that pain Does failure hurt? The effects of failure feedback on pain report, pain tolerance and pain avoidance Johanna H.C. van den Hout a,b , Johan W.S. Vlaeyen a,c , Madelon L. Peters a , Iris M. Engelhard a and Marcel A. van den Hout a a Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands b Institute for Rehabilitation Research, P.O. Box 192, 6430 AD Hoensbroek, The Netherlands c Pain Management and Research Center, University Hospital Maastricht, PO Box 5800, 6201 AZ Maastricht, The Netherlands In this study an experiment was conducted to examine whether failure experiences have an effect on pain report, pain tolerance and pain avoidance. Furthermore, it was investigated if negative affectivity (NA) affected the impact of failure feedback on pain report, either as a mediator, in the case of negative state affect, or as a moderator when NA as a personality trait was considered. Fifty-four healthy female volun- teers were included and randomly assigned to one of three conditions: (1) failure feedback; (2) success feed- back; (3) neutral control task. After the manipulation, subjects were given a cold pressor task in order to obtain pain measures. Regarding the effects of failure feedback on pain report, it was found that, in com- parison with success feedback, failure feedback led to increased pain report. With regard to pain tolerance, pain was tolerated for longer when preceded by success feedback than when preceded by failure feedback. Differences between failure and control conditions did not reach significance.With regard to pain avoid- ance, no differences between the conditions were found. The hypothesized mediating role of negative state affect was not found. Though in the hypothesized direction, no significant effect was found for NA-trait moderating the influence of failure on pain. The discussion focuses on a number of research questions that remain to be answered, and the clinical relevance of the effects of failure and success experiences on pain report and pain tolerance. © 2000 European Federation of Chapters of the International Association for the Study of Pain KEYWORDS: pain report, pain tolerance, pain avoidance, failure feedback, negative affectivity. Paper received 17 November 1999 and accepted in revised form 27 June 2000 Correspondence to: Anja van den Hout, Department of Medical, Clinical and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel: +31 43 3881601; Fax: +31 43 3884155; E-mail: anja.vandenhout@dep.unimaas.nl 1090-3801/00/040335 + 12 $35.00/0 © 2000 European Federation of Chapters of the International Association for the Study of Pain European Journal of Pain (2000) 4: 335–346 doi:10.1053/eujp.2000.0195, available online at http://www.idealibrary.com on