These findings reveal dissociable mechanisms underlying feedback effects and illustrate that feedback engages a multidimensional learning process that improves pain assessment beyond spontaneous adaptation. This highlights its potential to develop evidence-based training protocol in clinicals.

Participants reported higher confidence in the No-Feedback group than in the Feedback group across both tasks. In the Pain Intensity Assessment Task, higher confidence was associated with better performance in the Feedback group but not in the No-Feedback group.

For pain vs. no-pain judgments, higher perceived similarity was associated with better performance in both groups. For pain intensity assessment, higher perceived similarity was associated with better performance in the No-Feedback group but not in the Feedback group.

When considering the direction of error, feedback resulted in unbiased overall ratings, whereas the No-Feedback group showed a tendency to underestimate pain. This bias reduction was accompanied by improvements in both underestimation and overestimation trials in the Feedback group.

In the Pain Intensity Assessment Task, the Feedback group again showed greater accuracy (i.e., smaller rating bias) compared to the No-Feedback group. Importantly, the effect of feedback was not influenced by the targets’ subjective pain intensity, whereas ratings in the No-Feedback group were.

In the Pain vs. No Pain Judgment Task, the Feedback Group was more accurate than the No-Feedback Group. We also observed distinct learning dynamics: the Feedback group showed rapid early learning that plateaued over time, whereas the No-Feedback group showed no significant change in learning.

Forty-seven participants viewed videos of individuals undergoing thermal stimulation at varying intensities and assessed their pain. The Feedback group received the targets’ true pain ratings after each trial, whereas the No-Feedback group received no feedback.

Accurate recognition of others’ pain is critical for empathy and effective clinical care. Although some studies suggest that feedback can improve emotion recognition, the learning dynamics and sociocultural factors through which feedback enhances pain assessment remain unclear.

Feedback improves pain assessment accuracy and reduces underestimation bias when it’s absent, while reshaping learning dynamics, confidence, and sociocultural influences on these judgments.

Check out our new preprint below for details👇
osf.io/preprints/ps...

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#JNeurosci: @yilizhao.bsky.social, Lee, @laurenatlas.bsky.social et al. found that associative learning across contexts triggered overlapping brain pathways, suggesting that the brain may use the same network for learning in different contexts. https://doi.org/10.1523/JNEUROSCI.1103-25.2025

Delighted to share our latest article on brain mechanisms of pain, appetitive & aversive learning, led by @yilizhao.bsky.social & In-seon Lee, out now in @sfnjournals.bsky.social! We show that brain mechanisms of expectancy are domain general, not unique to pain! www.jneurosci.org/content/earl...

Overall, these findings suggest that shared neural circuits mediate the effects of learned expectations on perception, linking pain with other areas of affective processing and perception across domains.

Pain specificity was evident when we measured variations in stimulus intensity, whether we used univariate or multivariate approaches, but there was minimal evidence of specificity by modality or aversiveness when we examined cue effects on medium trials.

Notably, the left anterior insula mediated domain-general cue effects on subjective intensity and the thalamus mediated cue effects on subjective valence, which two regions were nearly identical to those previously implicated in mediating cue effects on pain (Atlas et al., 2010).

Results showed learned cues modulated expectations and subjective outcomes similarly across domains. Consistent with this, the orbitofrontal cortex exhibited domain-general anticipatory activation.

Sixty participants were randomly assigned to receive painful heat, unpleasant liquid saline, or pleasant liquid sucrose in the scanner. After conditioning, cues linked to low or high intensity outcomes were followed by stimuli calibrated to medium intensity ratings.

Predictive cues significantly influence perception through associative learning. However, it is unknown whether circuits are conserved across domains. We investigated how associative learning influences pain and hedonic tastes as a function of aversiveness and modality.

Check our new preprint about domain-general effects of expectation on pain and tastes 👇:https://www.biorxiv.org/content/10.1101/2025.04.10.648205v1