Optimism and the Experience of Pain: A Systematic Review

Identifying the psychological effects of nocebo education: results from two pre-registered experiments

Providing treatment side effect information to patients increases the risk of harm due to the nocebo effect. Nocebo education, in which patients learn about nocebo effects, is a novel strategy that can be used across a variety of situations and individuals to decrease unpleasant treatment side effects. It is currently unclear which psychological changes are induced by nocebo education, which is information required to maximize this intervention. Two pre-registered studies investigated the effects of nocebo education on side effect expectations, side effect control beliefs, feelings toward treatments, intentions to avoid or seek side effect information, and perceptions of treatment efficacy. In Study 1 (N = 220), adult participants either watched or did not watch a nocebo education intervention video prior to reading vignettes about receiving a surgical treatment for pain and a medication for pain. Study 2 (N = 252) was similar to Study 1, with the inclusion of a health behavior video control group and participants only reading about a medication treatment for pain. In both experiments, nocebo education reduced global side effect expectations and increased side effect self-efficacy beliefs. Nocebo education also increased intentions to avoid side effect information and decreased intentions to seek more side effect information. Evidence was inconclusive on whether nocebo education changes affective associations with the treatments. The findings demonstrate that nocebo education has a multi-faceted influence with the potential to change patient behavior. The results can be used to improve the management of adverse treatment side effects.

Challenges faced by internally displaced diabetes patients in managing their health during a conflict: a qualitative study

BACKGROUND

This study examines the experiences of diabetic patients who were displaced during the Israel-Hamas conflict, highlighting the substantial challenges they face in managing their health under these circumstances.

METHODS

A qualitative-phenomenological approach was employed, focusing on the experiences of 14 individuals with diabetes who were displaced during the conflict. Data were collected through semi-structured interviews and subsequently subjected to content analysis.

RESULTS

Three central themes emerged: (1) "I left without clothes and medications": Participants described the chaotic evacuation process and the difficulty in maintaining diabetes care without their supplies. (2) "Dual coping": Participants struggled with managing their diabetes while adapting to new, temporary living conditions that disrupted their care routines. (3) Seeking inner resilience while drawing strength from external support: This theme reflected the importance of internal resilience and support from family, friends, and healthcare professionals in coping with health management and displacement challenges.

CONCLUSIONS

The study underscores the significant challenges diabetes patients face during conflict evacuation, including disruptions in their routine care, heightened psychological stress, and the essential role of support systems. These findings underscore the need for emergency preparedness plans to ensure continuity of care for patients with chronic conditions during crises.

Differences in the relationship between pain and anxiety in total knee and hip arthroplasty: a longitudinal cross-lagged analysis mediated by depression and pain catastrophizing

Acute postsurgical pain (APSP) is an important risk factor for pain chronification, with reports of being more intense after total knee arthroplasty (TKA) than after total hip arthroplasty (THA). Psychological variables have been associated with differences in postsurgical pain experience. This study aimed to analyse the longitudinal reciprocal association between pain and anxiety levels in patients undergoing TKA or THA, to investigate the moderator role of the type of surgery and to explore psychological mediators in the anxiety - pain association. Patients undergoing TKA (n = 120) or THA (n = 109) were evaluated before surgery and in the acute postsurgical period (48 h postsurgery). Presurgical assessment comprised sociodemographic, pain-related and psychological variables (anxiety, depression, pain catastrophizing, self-efficacy, optimism and satisfaction with life). Postsurgical assessment focused on pain frequency, pain intensity and anxiety. Longitudinal associations were explored using cross-lagged panel models that included the indirect effect paths through possible mediators (pain catastrophizing and depression). Multigroup analyses compared TKA and THA. In the global sample, higher APSP was predicted by higher presurgical pain and worse presurgical anxiety. Multigroup analyses revealed that worse APSP was predicted by higher presurgical anxiety in patients undergoing TKA and by higher presurgical pain in patients undergoing THA. Furthermore, there was a positive significant indirect effect of pain catastrophizing, but not depressive symptoms, in the relationship between presurgical anxiety and APSP in THA. Anxiety and APSP are differently interrelated in TKA and THA. Psychological characteristics could be managed before surgery to favour better APSP control and potentially prevent pain chronification after total joint arthroplasty.

Explaining the Components of Resilience in Patients with Chronic Pain: A Qualitative Content Analysis

Background

Resilience is a psychological trait and a protective factor that plays a vital role in coping with Chronic Pain (CP). Despite its importance, research has yet to fully clarify the concept and components of resilience in patients with CP. Accordingly, the present study aims to explain the components of resilience in patients with CP.

Materials and Methods

The current qualitative study used a conventional content analysis methodology. The research population included all patients with CP who were referred to clinics affiliated with Shiraz University of Medical Sciences (south of Iran) from August 2021 to August 2022. Participants were selected using the purposive sampling method. In-depth semi-structured interviews were conducted with 20 participants to collect information. Data analysis was conducted using MAXQDA 2020 software in conjunction with data collection efforts.

Results

Generally, in the current study, 30 sub-sub-categories, 11 sub-categories, and five main categories were extracted as components of resilience in patients with CP. The main categories of resilience against CP included the following: 1. emotional self-regulation, 2. psychological flexibility, 3. self-care, 4. appeal to religion-spirituality, and 5. internal resources and individual competencies.

Conclusions

The present study highlights the different physical, mental, and religious-spiritual strategies that may contribute to resilience against pain. The resilience components identified in this study provide a foundation for healthcare professionals, particularly nurses, to design and implement diverse pain management strategies that enhance adjustment to CP conditions.

Nocebo hyperalgesia and other expectancy-related factors in daily fibromyalgia pain: Combining experimental and electronic diary methods

OBJECTIVE

Expectancies are known to shape pain experiences, but it remains unclear how different types of expectancies contribute to daily pain fluctuations in fibromyalgia. This combined experimental and diary study aims to provide insights into how experimentally-derived nocebo hyperalgesia and other, diary-derived, expectancy-related factors are associated with each other and with daily pain in fibromyalgia.

METHODS

Forty-one female patients with fibromyalgia first participated in a lab procedure measuring nocebo hyperalgesia magnitude, then filled out an electronic diary 3 times a day over 3 weeks regarding the expectancy-related factors of pain expectancy, anxiety, optimism, and pain-catastrophizing thoughts, and current pain intensity.

RESULTS

Our results indicate that experimentally-induced nocebo hyperalgesia was not significantly related to diary-assessed expectancy-related factors and did not predict daily fibromyalgia pain. Higher levels of the self-reported expectancy-related factors pain expectancy and pain catastrophizing, but not anxiety and optimism, predicted moment-to-moment pain increases in fibromyalgia, after controlling for current pain, moment-of-day and all other expectancy-related factors.

CONCLUSION

Our exploratory research findings indicate that self-reported expectancy-related factors, particularly pain expectancy and pain catastrophizing, are potentially more relevant for predicting daily pain experience than experimentally-induced nocebo hyperalgesia. Further translation of nocebo hyperalgesia is needed from experimental to Ecological Momentary Assessment research. Our findings imply that targeting the decrease in pain expectancy and catastrophizing thoughts e.g., via Cognitive Behavioral Therapy, have potential for improving daily pain levels in fibromyalgia.

Broadening the Scope of Resilience in Chronic Pain: Methods, Social Context, and Development

PURPOSE OF REVIEW

A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience.

RECENT FINDINGS

Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain.

Societal beliefs about pain may be more balanced than previously thought. Results of the Guernsey pain survey

BACKGROUND

Musculoskeletal pain is multidimensional and associated with significant societal impact. Persistent or chronic pain is a public health priority. A step towards high-value care is a contemporary understanding of pain. While pain-related knowledge has been examined in specific conditions (e.g. neck pain) knowledge of the public's broader understanding regarding musculoskeletal pain per se, warrants investigation. This study examined the public's knowledge and beliefs regarding musculoskeletal pain and pain management.

METHODS

This observational cohort study was conducted in Guernsey (January 2019-February 2020). Participants (n = 1656; 76.0% female) completed an online questionnaire capturing: demographics, pain experience, work absenteeism, understanding of pain and pain management, multidimensional influences, physical activity, pain catastrophising and healthcare decision-making. Statements were deemed true/false/equivocal and mapped to biopsychosocial/biomedical/neutral perspectives based upon contemporary literature. Descriptive statistics were analysed for each statement. Participants' responses were examined for alignment to a contemporary viewpoint and themes within responses derived using a semi-quantitative approach modelled on direct content analysis. Comparisons between participants with/without pain were examined (χ2-squared/Wilcoxon Rank Sum test).

RESULTS

Within the cohort 83.6% reported currently experiencing pain. The overarching theme was perspectives that reflected both biomedical and contemporary, multidimensional understandings of pain. Sub-themes included uncertainty about pain persistence and evidence-based means to reduce recurrence, and reliance upon healthcare professionals for guiding decision-making. Compared to those with pain, those without had a greater belief that psychological interventions may help and lower pain catastrophising.

CONCLUSIONS

Participants' understanding of pain demonstrated both biomedical and multidimensional pain understanding consistent with elements of a contemporary understanding of pain.

Perceived Benefits of Magdalena Energy Healing Sessions: An Exploratory Study of Clients' Perspectives

BACKGROUND

Energy healing techniques are associated with many physical and mental benefits. A qualitative study was conducted to understand clients' experiences of a new energy healing modality called Magdalena Energy Healing.

METHODS

Semi-structured qualitative interviews were conducted after clients experienced 60 min Magdalena energy healing session(s). Twenty-five adults participated in the study. All participants received Magdalena energy healing from a certified, trained practitioner. Thematic analysis was conducted to determine clients' perceived benefits of the Magdalena energy healing session(s).

RESULTS

Four themes emerged from the data: Physical, Mental, Social, and Spiritual Benefits. Physical health benefits included relief from a variety of medical symptoms, improved sleep quality, and physical body awareness. Mental Health benefits included relaxation and peace, decision-making clarity, relief of mental health symptoms, and an increased ability to cope with life. Social Benefits included improved attitudes in relationships. Spiritual Benefits included optimism, gratitude, self-acceptance, and increased spiritual connection.

CONCLUSIONS

Participants' perceptions are that Magdalena energy healing sessions offer peace, symptom relief, and gratitude. Magdalena energy healing can address priorities of The National Center for Complementary and Integrative Health (NCCIH). Sessions can be seamlessly integrated into traditional medical care as a useful complementary/integrative healing option to improve physical, mental, and/or spiritual wellbeing across a variety of diseases.

Psychological predictors of acute postoperative pain after total knee and hip arthroplasty: A systematic review

BACKGROUND

Identifying patients at high risk of acute postoperative pain after total knee or hip arthroplasty (TKA/THA) will facilitate individualized pain management and research on the efficacy of treatment options. Numerous studies have reported that psychological patient factors may influence acute postoperative pain, but most reviews have focused on chronic pain and functional outcomes. This systematic review aims to evaluate which psychological metrics are associated with acute postoperative pain after TKA and THA.

METHODS

A systematic search was conducted using the databases PubMed, EMBASE, Web of Science, and Cochrane Library until June 2022. Full-text articles reporting associations of preoperative psychological factors with acute pain within 48 h of TKA or THA surgery were identified. Quality was assessed using the Quality in Prognostic Studies tool.

RESULTS

Eighteen studies containing 16 unique study populations were included. TKA was the most common procedure, and anxiety and depression were the most evaluated psychological metrics. Several different anesthetic techniques and analgesic regimens were used. The studies were generally rated as having a low to moderate risk of bias. Catastrophizing was associated with acute pain in six studies (of nine), mainly after TKA. In contrast, three studies (of 13) and two studies (of 13) found anxiety and depression, respectively, to be associated with acute postoperative pain.

CONCLUSION

Pain catastrophizing seemed to be the most consistent psychological predictor of acute postoperative pain after TKA. The results for other psychological factors and THA were inconsistent. However, the interpretation of results was limited by considerable methodological heterogeneity.

Relationship between Optimism, Self-Efficacy and Quality of Life: A Cross-Sectional Study in Elderly People with Knee Osteoarthritis

BACKGROUND

Due to the presence of numerous problems in osteoarthritis, e.g., the presence of one or more chronic diseases, reduced self-esteem and reduced ability to cope, patients must undertake readaptation activities. In such circumstances, resources that are necessary for optimal adaptation become of particular importance. This cross-sectional study aimed to assess the impact of behavioral resources, namely self-efficacy and optimism, on quality of life perception in early-old-age patients with knee osteoarthritis.

METHODS

An anonymous survey was conducted using recognized research tools: the Index of Severity for Knee Disease, Life Orientation Test, General Self-Efficacy Scale and World Health Organization Quality of Life BEFF. The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without diagnosed joint and muscular diseases of the lower limbs. Non-parametric tests (e.g., Mann-Whitney U test, Kruskal-Wallis test, Spearman's correlation coefficient) were used for the statistical analysis of the results, assuming a significance level of p < 0.05.

RESULTS

The level of the examined personal resources was significantly lower in the group of people with gonarthrosis (p < 0.001), among whom low self-efficacy and a tendency toward pessimism prevailed. The results in terms of the level of lower limb joints impairment among the respondents correlated significantly and negatively with self-efficacy (r = -0.239; p = 0.003) and dispositional optimism (r = -0.318; p < 0.001). A higher level of the studied psychosocial resources led to a more favorable assessment of quality of life (p < 0.001) and own health (p < 0.001). In addition, a higher sense of self-competence was associated with better quality of life in the psychological (p = 0.044), social (p < 0.001) and environmental (p < 0.001) domains, while a tendency toward optimism was associated with higher quality of life perception in the social domain (p < 0.001).

CONCLUSIONS

It would seem to be reasonable to introduce a routine diagnosis, assessing the level of personal capabilities of elderly people with knee osteoarthritis, which may have a beneficial effect on their perception of their quality of life and their own health.

The effect of induced optimism on early pain processing: indication by contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR)

Situationally induced optimism has been shown to influence several components of experimental pain. The aim of the present study was to enlarge these findings for the first time to the earliest components of the pain response by measuring contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR). Forty-seven healthy participants underwent two blocks of phasic thermal stimulation. CHEPs, the SSR and self-report pain ratings were recorded. Between the blocks of stimulation, the 'Best Possible Self' imagery and writing task was performed to induce situational optimism. The optimism manipulation was successful in increasing state optimism. It did, however, neither affect pain-evoked potentials nor the SSR nor self-report pain ratings. These results suggest that optimism does not alter early responses to pain. The higher-level cognitive processes involved in optimistic thinking might only act on later stages of pain processing. Therefore, more research is needed targeting different time frames of stimulus processing and response measures for early and late pain processing in parallel.

Shifting the perspective: how positive thinking can help diminish the negative effects of pain

OBJECTIVES

The field of pain psychology has taken significant steps forward during the last decades and the way we think about how to treat chronic pain has radically shifted from a biomedical perspective to a biopsychosocial model. This change in perspective has led to a surge of accumulating research showing the importance of psychological factors as determinants for debilitating pain. Vulnerability factors, such as pain-related fear, pain catastrophizing and escape/avoidant behaviours may increase the risk of disability. As a result, psychological treatment that has emerged from this line of thinking has mainly focused on preventing and decreasing the adverse impact of chronic pain by reducing these negative vulnerability factors. Recently, another shift in thinking has emerged due to the field of positive psychology, which aims to have a more complete and balanced scientific understanding of the human experience, by abandoning the exclusive focus on vulnerability factors towards including protective factors.

METHODS

The authors have summarised and reflected on the current state-of-the-art of pain psychology from a positive psychology perspective.

RESULTS

Optimism is an important factor that may in fact buffer and protect against pain chronicity and disability. Resulting treatment approaches from a positive psychology perspective are aimed at increasing protective factors, such as optimism, to increase resilience towards the negative effects of pain.

CONCLUSIONS

We propose that the way forward in pain research and treatment is the inclusion of both vulnerability and protective factors. Both have unique roles in modulating the experience of pain, a finding that had been neglected for too long. Positive thinking and pursuing valued goals can make one's life gratifying and fulfilling, despite experiencing chronic pain.

Predicting the Need for Transition from Pediatric to Adult Pain Services: A Retrospective, Longitudinal Study Using the Electronic Persistent Pain Outcome Collaboration (ePPOC) Databases

A proportion of youth with chronic pain do not respond to interdisciplinary pain management and may require transition to adult pain services. This study sought to characterize a cohort of patients referred to pediatric pain services who subsequently required referral to an adult pain service. We compared this transition group with pediatric patients eligible by age to transition but who did not transition to adult services. We sought to identify factors predicting the need to transition to adult pain services. This retrospective study utilized linkage data from the adult electronic Persistent Pain Outcomes Collaboration (ePPOC) and the pediatric (PaedePPOC) data repositories. The transition group experienced significantly higher pain intensity and disability, lower quality of life, and higher health care utilization relative to the comparison group. Parents of the transition group reported greater distress, catastrophizing, and helplessness relative to parents in the comparison group. Three factors significantly predicted transition: compensation status (OR = 4.21 (1.185-15)), daily anti-inflammatory medication use (OR = 2 (1.028-3.9)), and older age at referral (OR = 1.6 (1.3-2.17)). This study demonstrated that patients referred to pediatric pain services who subsequently need transition to adult services are a uniquely disabled and vulnerable group beyond comparative peers. Clinical applications for transition-specific care are discussed.

The role of optimism in manifesting recovery outcomes after coronary artery bypass graft surgery: A systematic review

OBJECTIVE

Coronary artery bypass graft (CABG) is a major surgery conducted in coronary heart disease management. Postoperative recovery is a crucial process for patients undergoing CABG. This systematic review evaluates current evidence regarding the association between trait optimism and recovery outcomes in patients following coronary artery bypass graft surgery.

METHODS

This review followed the Preferred Reporting Items of Systematic Review and Meta-Analysis (PRISMA) 2020 Guideline. The inclusion criteria focused on observational study that examined study participants aged ≥18 years old undergoing elective CABG and measurement of trait optimism with validated methods (i.e. LOT, LOT-R) and at least one recovery outcome. Studies in non-English languages and duplicates were excluded. A systematic literature search was carried out on PubMed, Scopus, and Web of Science electronic databases. Search results were screened based on the eligibility criteria. The Newcastle-Ottawa Scale was used to assess the quality of each included study.

RESULTS

The search yielded a total of 1853 articles, in which 7 articles fulfilled the eligibility criteria and were subsequently included in the analysis. Measurement of trait optimism was conducted on 1276 patients who underwent a non-emergency/elective CABG. Optimism was significantly associated with several categories of recovery, including reduced rehospitalization rate, complications, pain, and physical symptoms along with improved quality of life, rate of return to normal life, and psychological status.

CONCLUSION

Our review showed that trait optimism was associated with recovery outcomes following CABG surgery. However, the heterogeneity of recovery outcomes may hamper the clinical benefit of trait optimism in CABG. (PROSPERO CRD42022301882).

"It Really Is an Elusive Illness"-Post-COVID-19 Illness Perceptions and Recovery Strategies: A Thematic Analysis

A substantial number of patients report persisting symptoms after a COVID-19 infection: so-called post-COVID-19 syndrome. There is limited research on patients' perspectives on post-COVID-19 symptoms and ways to recover. This qualitative study explored the illness perceptions and recovery strategies of patients who had been hospitalised for COVID-19. Differences between recovered and non-recovered patients were investigated. Semi-structured in-depth interviews were held with 24 participating patients (8 recovered and 16 non-recovered) 7 to 12 months after hospital discharge. Data were interpreted using reflexive thematic analysis. Four overarching themes were identified: (I) symptoms after hospital discharge; (II) impact of COVID-19 on daily life and self-identity; (III) uncertainty about COVID-19; and (IV) dealing with COVID-19. Formerly hospitalised post-COVID-19 patients seem to have difficulties with making sense of their illness and gaining control over their recovery. The majority of non-recovered participants continue to suffer mostly from weakness or fatigue, dyspnoea and cognitive dysfunction. No notable differences in illness beliefs were observed between recovered and non-recovered participants.

The Effect of Induced Optimism on Situational Pain Catastrophizing

Background

There is broad evidence that optimism is associated with less pain, while pain catastrophizing leads to increased pain. The aim of this study was to examine whether experimentally induced optimism can reduce situational pain catastrophizing and whether this relation is moderated by dispositional optimism and/or dispositional pain catastrophizing.

Methods

Situational pain catastrophizing during two thermal stimulations was measured in 40 healthy participants with the Situational Catastrophizing Questionnaire (SCQ). Between the two stimulations, the Best Possible Self (BPS) imagery and writing task was performed to induce situational optimism in the experimental group while the control group wrote about their typical day. Questionnaires were administered to assess dispositional optimism [Life Orientation Test-Revised (LOT-R)] and dispositional pain catastrophizing [Pain Catastrophizing Scale (PCS)].

Results

There was a significant interaction between the optimism induction and trait pain catastrophizing: the association of trait pain catastrophizing with state pain catastrophizing was weakened after the optimism induction. No overall effect of induced optimism on situational pain catastrophizing and no significant moderating influence of trait optimism were found.

Conclusion

The state optimism induction apparently counteracted the manifestation of dispositional pain catastrophizing as situational pain catastrophizing. This implies that high trait pain catastrophizers may have especially benefitted from the optimism induction, which is in line with resilience models stressing the buffering role of optimism.

Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study

Objectives

The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain.

Design

A three-round modified Delphi study.

Participants

Forty international experts.

Methods

In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don’t know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0–10 Likert scale. Consensus was reached if ≥ 75% of experts rated the questionnaire ≥7.

Results

From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires.

Conclusion

We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.

The induction of social pessimism reduces pain responsiveness

OBJECTIVES

Past work has found that optimism reduces a person's responsiveness to pain, but the effects of pessimism are not clear. Therefore, we gave pessimistic forecasts of participants' future social life and measured changes in their pain responsiveness. In particular, some participants were told that they would end up alone in life.

METHODS

Seventy-five subjects were investigated in three conditions (negative forecast, positive forecast, no forecast) for changes in pain threshold and pain tolerance threshold. Pressure pain induction was accomplished by either human- or machine-driven algometers. A randomly assigned bogus forecast promising either a lonely or a socially satisfying future was ostensibly based on a personality questionnaire and an emotional dot-probe task. As potential covariates, questionnaires assessing dispositional optimism (LOT-R), pain catastrophizing (PCS), and self-esteem (SISE) were given.

RESULTS

Pain thresholds suggested a change toward unresponsiveness only in the negative forecast condition, with only small differences between the modes of pain induction (i.e., human or machine). The results for pain tolerance thresholds were less clear also because of limiting stimulation intensity for safety reasons. The covariates were not associated with these changes.

CONCLUSIONS

Thus, people expecting a lonely future became moderately less responsive to pain. This numbing effect was not modulated by personality measures, neither in a protective fashion via dispositional optimism and self-esteem nor in a risk-enhancing fashion via trait pain catastrophizing. Alternative mechanisms of action should be explored in future studies.

Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS)

Background

Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors of work resumption after back surgery.

Methods

In this multisite, prospective, longitudinal study, 300 individuals with radicular pain undergoing a lumbar decompression will be followed until 1-year post-surgery. Prior to surgery, participants will perform a computer task to assess fear of movement-related pain, avoidance behavior, and their generalization to novel situations. Before and immediately after surgery, participants will additionally complete questionnaires to assess fear of movement-related pain, avoidance behavior, optimism, expectancies towards recovery and work resumption, and the duration and severity of the pain. Six weeks, 3 months, 6 months, and 12 months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. The primary hypothesis is that (generalization of) fear of movement-related pain and avoidance behavior will negatively affect sustainable work resumption after back surgery. Second, we hypothesize that (generalization of) fear of movement-related pain and avoidance behavior, negative expectancies towards recovery and work resumption, longer pain duration, and more severe pain before the surgery will negatively affect work resumption, pain severity, disability, and quality of life after back surgery. In contrast, optimism and positive expectancies towards recovery and work resumption are expected to predict more favorable work resumption, better quality of life, and lower levels of pain severity and disability after back surgery.

Discussion

With the results of this research, we hope to contribute to the development of strategies for early identification of risk factors and appropriate guidance and interventions before and after back surgery.

Trial registration The study was preregistered on ClinicalTrials.gov: NCT04747860 on February 9, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00736-5.

The Impact of Optimism on Cancer-Related and Postsurgical Cancer Pain: A Systematic Review

BACKGROUND

The impact of psychological factors on pain levels continues to be of interest throughout a cancer patient's journey. The relationship between pain and optimism has been described previously in patients with various diseases.

OBJECTIVES

We further investigated the effect of optimism on pain levels felt by patients diagnosed and living with cancer before and after surgery.

MATERIALS AND METHODS

The search strategy for relevant articles from inception through June 2020 included five databases. The main outcome of interest was the effect of optimism on cancer-related pain.

RESULTS

We identified 482 studies. After the full-text screening, seven articles meeting the inclusion criteria were included. Seven studies were analyzed and are included in the data table. Of the seven included articles, four articles described the association of optimism with cancer pain; four articles studied the relationship between optimism and chronic postsurgical pain (CPSP), and one article investigated optimism's relationship with acute postsurgical pain (APSP). All articles observed a negative correlation between optimism and pain levels.

CONCLUSION

Despite the differences in the pathophysiology of pain types investigated, and which stage of the patient's journey pain was experienced, all studies reported a negative association with the level of optimism and pain described by patients. Therefore, promoting and supporting psychological coping techniques, including optimism for cancer patients may decrease patients' suffering, increase their quality of life at different cancer stages, and reduce opioid use.

Resilience mediates the influence of hope, optimism, social support, and stress on anxiety severity among Chinese patients with cervical spondylosis

OBJECTIVE

Cervical spondylosis (CS) is a potential stressor threatening mental health among affected individuals. This study was to analyze resilience level and associated factors among cervical spondylosis (CS) patients, and to explore the underlying mechanism of anxiety based on resilience-focused psychological variables.

METHODS

Resilience Scale-14 (RS-14), Zung Self-Rating Anxiety Scale (SAS), Herth Hope Index (HHI), Revised Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale-10 (PSS-10) were used in this cross-sectional investigation among 250 CS patients.

RESULTS

The score of resilience was 65.58 ± 16.14. Hierarchical linear regression analysis revealed that hope, optimism, perceived social support, perceived stress, and whether having comorbid chronic diseases were the independent associates of resilience among CS patients, which explained 63.9% of the total variance. The structural equation model showed that hope, optimism, perceived social support and perceived stress affected anxiety via resilience, and hope and optimism also had direct effects on anxiety.

CONCLUSION

Chinese patients with CS had moderate level of mental resilience, which was independently related to hope, optimism, perceived social support, perceived stress, and whether having comorbid chronic diseases. Resilience played a mediating role between various psychological variables and anxiety. Improving the level of resilience, hope, optimism and perceived social support and reducing the level of perceived stress are important strategies to reduce anxiety level. Relevant healthcare professionals should put more focus on the mental problems of Chinese CS patients and help maintain good psychological status by improving their resilience and associated psychological variables thereof.

Development of the Pain Responses Scale: A measure informed by the BIS-BAS model of pain

BACKGROUND

The behavioural inhibition system and activation system (BIS-BAS) model of pain focusses on two clusters of responses to pain-escape/avoidance (BIS) and approach (BAS) behaviours. While the BIS-BAS model emphasizes active responses to pain, deactivation responses such as despondence and relaxation are also common. This study sought to develop self-report scales assessing cognitive, behavioural intentions and affective responses to pain consistent with this extended BIS-BAS framework. We also sought to develop short-forms of the emerging scales.

METHODS

Confirmatory factor analysis was performed to derive scales from a large item pool administered to a community sample with heterogeneous chronic pain (N = 476).

RESULTS

The items resulted in 16 scales assessing Thoughts, Affective responses, Behavioural Intentions and Valence-Associated Thoughts, which loaded on to the four theorized types of pain responses-Escape, Approach, Despondence and Relaxation-with the four emerging short-form scales assessing these overarching factors. The internal consistency reliabilities of the long-forms generally ranged from good to excellent (αs ≥ 0.83), with the exception of the Relaxation-Behavioural Intentions scale (α = 0.64). The four short-forms demonstrated at least adequate internal consistency reliability (αs ≥ 0.79). An initial test of the construct validity of the scales in relation to pain-related outcomes is also reported.

CONCLUSIONS

We anticipate that the Pain Responses Scale (PRS) developed from this research will be useful for assessing mechanisms targeted by many psychosocial pain treatments and will provide a nuanced understanding of the shared versus specific nature of these mechanisms.

SIGNIFICANCE

The Pain Responses Scale emerging from this research assesses four theorized, overarching responses to pain: Escape, Approach, Giving Up and Relaxation. This measure will afford the capacity to test a reconceptualized BIS-BAS model of pain and inform treatments that are adapted based on this framework.

Are positive psychology interventions efficacious in chronic pain treatment? A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Although positive psychology interventions are increasingly popular in chronic pain treatment their efficacy is still unclear. The objective is to summarize evidence on the effect of positive psychology interventions (PPIs) on pain, physical functioning, and emotional functioning in adults with chronic pain.

METHODS

Four electronic databases and additional references were searched for randomized controlled trials published between 1990 and 2020. Findings from included studies were qualitatively and quantitatively synthesized, and study quality was assessed for risk of bias. A random effects meta-analysis model was applied for outcomes with more than four findings.

RESULTS

Of 16 included randomized controlled trials, almost half delivered positive psychology interventions as self-help online interventions, and half conducted guided face-to-face interventions which lasted mostly eight weeks. Results from meta-analysis showed beneficial effects of positive psychology interventions compared to the control group on pain intensity and emotional functioning (i.e., less depressive symptoms, pain catastrophizing, negative affect; more positive affect) post-intervention. At 3-month follow-up, beneficial effects were maintained for depressive symptoms and positive and negative affect, but not for pain catastrophizing. However, the evidence on the long-term efficacy of PPIs and the efficacy of PPIs on physical functioning remains limited.

CONCLUSION

This review supports the notion that positive psychology interventions are beneficial to chronic pain treatment, although further, high quality research is needed to support this conclusion.

Exploring the relationship among dispositional optimism, health-related quality of life, and CIPN severity among colorectal cancer patients with chronic peripheral neuropathy

Purpose

Chemotherapy-induced peripheral neuropathy ((CI)PN) becomes chronic in 30% of cancer patients. Knowledge of predictors of chronic (CI)PN and related impairments in health-related quality of life (HRQoL) is lacking. We examined the role of optimism in chronic (CI)PN severity and associated HRQoL in colorectal cancer (CRC) patients up to two years after diagnosis.

Methods

CRC patients from a prospective cohort study participated, with sensory peripheral neuropathy (SPN) 1 year after diagnosis (n = 142). Multivariable regression analyses examined the cross-sectional association between optimism (measured by the LOT-R) and SPN severity/HRQoL (measured by the EORTC QLQ-CIPN20 and QLQ-C30), as well as the prospective association in a subsample that completed measures 2 years after diagnosis and still experienced SPN (n = 86).

Results

At 1-year follow-up, higher optimism was associated with better global HRQoL, and better physical, role, emotional, cognitive, and social functioning (all p < .01). Optimism at year one was also prospectively associated with better global HRQoL (p < .05), and emotional and cognitive functioning at 2-year follow-up (both p < .01). Optimism was not related to self-reported SPN severity. Significant associations were retained when controlling for demographic/clinical variables, and became non-significant after controlling for depressive and anxiety symptoms.

Conclusions

Optimism and depressive and anxiety symptoms are associated with HRQoL in CRC patients with chronic (CI)PN. Future research may illuminate the mechanisms that these factors share, like the use of (non)adaptive coping styles such as avoidance and acceptance that may inform the design of targeted interventions to help patients to adapt to chronic (CI)PN.

The effect of optimism on the facial expression of pain: Implications for pain communication

BACKGROUND

There is a broad range of evidence on optimism dampening the pain experience, as assessed by subjective self-report. Facial expression of pain conveys supplementary information about the pain experience, is an integral part of pain communication and assists psychosocial pain coping. Nevertheless, the effect of induced optimism on facial activity during pain has to our knowledge not been examined.

METHODS

In our experiment, 40 healthy participants underwent two blocks of thermal stimulation containing phasic non-painful and painful stimuli. Between the two blocks, the Best Possible Self imagery and writing task was performed to induce situational optimism, while a control group wrote about their typical day. Facial activity and self-report ratings of intensity and unpleasantness were recorded. Facial activity was analysed using the Facial Action Coding System.

RESULTS

The optimism manipulation was successful in increasing state optimism. It did not affect self-report ratings, but resulted in a stronger facial expression of pain, caused especially by increases in Action Units 4 (furrowed brows) and 6_7 (narrowed eyes).

CONCLUSIONS

All Action Units, which were affected by the optimism induction, are known to be prevalent during pain stimulation. The increase in facial expression might reflect reduced inhibition of pain communication in temporarily optimistic participants. Optimism might lead to expecting positive and helpful reactions from others and, by that, to great readiness to elicit these reactions by non-verbal social behaviour.

SIGNIFICANCE

This study is the first to indicate that state optimism increases the facial expression of pain as a social signal for help and empathy without concomitant changes in the subjective pain experience.

Psychosocial resources and chronic pain in individuals with spinal cord injury: evidence from the second Swiss national community survey

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To investigate the associations of a set of psychosocial resources with pain and pain-related factors in individuals with spinal cord injury (SCI) and chronic pain.

SETTING

Community, Switzerland.

METHODS

Data from 1,064 individuals with chronic pain who participated in the second community survey of the Swiss Spinal Cord Injury Cohort Study (Survey 2017) were analyzed. Multiple linear regression modeling was performed to test the hypotheses that higher levels of psychosocial resources (self-efficacy, self-esteem, purpose in life, optimism, hope, social support, sense of belonging) are negatively associated with pain intensity, pain interference and depressive symptoms.

RESULTS

Higher self-esteem, optimism and hope were related to less pain interference and all psychosocial resources under study were negatively associated with depressive symptoms in final models. However, neither of the psychosocial resources was related to pain intensity when models were adjusted for pain interference and depressive symptoms.

CONCLUSIONS

These findings strengthen the evidence that psychosocial resources can have an impact on pain interference and depressive symptoms as pain-related factors, and support the notion that psychosocial resources might be promising targets for pain interventions in individuals with SCI.

The Role of Positive Psychological Factors in the Association between Pain Intensity and Pain Interference in Individuals with Chronic Musculoskeletal Pain: A Cross-Sectional Study

This study aimed to test the cross-sectional mediating and moderating role that positive psychological factors play in the association between pain intensity and pain interference in individuals with chronic musculoskeletal pain. A descriptive cross-sectional study using mediation analyses was conducted, including 186 individuals with chronic musculoskeletal pain. We conducted cross-sectional mediation and moderation analyses to determine whether the positive psychological factors mediated or moderated the association between pain intensity and pain interference. Pain acceptance, pain self-efficacy, and optimism were all significantly and weakly related to pain interference when controlling for pain intensity. Pain self-efficacy and pain acceptance partially mediated the association between pain intensity and pain interference. On the other hand, the multiple mediation model did not show significant effects. The three positive psychological factors were not found to significantly moderate the association between pain intensity and pain interference. The findings suggest that in chronic musculoskeletal pain patients, the treatments may focus on [i] what they are capable of doing to manage the pain (i.e., pain self-efficacy) and [ii] being better able to accept the pain as pain waxes and wanes might be also particularly helpful. However, these results must be tested in longitudinal studies before drawing any causal conclusion.

Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies

OBJECTIVE

The objective of this study was to summarize the current status of knowledge about the longitudinal association between vulnerability or protective psychological factors and the onset and/or persistence of musculoskeletal (MSK) pain.

METHODS

PubMed, CINAHL, PsycINFO, PubPsych, Scopus, Web of Science, gray literature, and manual screening of references were searched from inception to June 15, 2019. Systematic reviews with or without meta-analysis that explored the longitudinal association between psychological factors and the onset and/or persistence of MSK pain were identified. The AMSTAR-2 tool was used to assess the risk of bias.

RESULTS

Fifty-nine systematic reviews that included 286 original research studies were included, with a total of 249,657 participants (127,370 with MSK pain and 122,287 without MSK pain at baseline). Overall, our results found that exposure to many psychological vulnerability factors such as depression, anxiety, psychological distress, and fear, among others, may increase the risk of the onset and persistence of MSK pain across time. In addition, our results also showed that a range of psychological factors considered to be "protective" such as self-efficacy beliefs, better mental health, active coping strategies, or favorable expectations of recovery may reduce the risk of the onset and persistence of MSK pain. However, all these systematic reviews were evaluated to have critically low confidence based on the AMSTAR-2 tool, indicating that findings from these reviews may be informative, but should be interpreted with caution.

DISCUSSION

The large number of methodological flaws found across reviews gives rise to a call to action to develop high-quality systematic reviews in this field.

Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link?

OBJECTIVE

To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.

METHOD

Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus.

RESULTS

There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus.

CONCLUSION

Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.

The effects of recovery sleep on pain perception: A systematic review

Experimental studies highlight profound effects of sleep disruptions on pain, showing that sleep deprivation (SD) leads to hyperalgesic pain changes. On the other hand, given that sleep helps normalizing bodily functions, a crucial role of restorative sleep in the overnight restoration of the pain system seems likely. Thus, a systematic review of experimental studies on effects of recovery sleep (RS; subsequently to SD) on pain was performed with the aim to check whether RS resets hyperalgesic pain changes occurring due to SD. Empirical animal and human studies including SD-paradigms, RS and pain assessments were searched in three databases (PubMed, Web of Science, PsycINFO) using a predefined algorithm. 29 studies were included in this review. Most results indicated a reset of enhanced pain sensitivity and vulnerability following RS, especially when total SD was implemented and pressure pain or painful symptoms (human studies) were assessed. Further research should focus on whether and how recovery is altered in chronic pain patients, as this yields implications for pain treatment by enhancing or stabilizing RS.