Evaluating psychosocial contributions to chronic pain outcomes

In the paper

“Expectations regarding pain also impact pain perception.”

What the sources say

• Partly supported

  The paper’s introductory discussion defines catastrophizing as a negative cognitive set during actual or anticipated pain and reports its association with heightened pain experience. That supports a narrower link between pain-related thinking and reported pain, but the paper does not establish that expectations generally cause changes in pain perception. (LLM, conf=0.82)

  cites [244] sourceExperimental — accuracy not yet measured

In the paper

“These psychosocial factors then influence individual variability in pain-related outcomes.”

In the paper

“psychosocial variables such as depression, anxiety, and distress are among the most potent and robust predictors of the transition from acute to chronic pain 13–18.”

What the sources say

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In the paper

“longitudinal, observational research supports a strong bidirectional link between mood disorders and persistent pain”

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In the paper

“the development of an enduring pain condition confers a substantially increased vulnerability for the subsequent diagnosis of an affective disorder”

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In the paper

“trait-based positive affect may buffer maladaptive pain-related behaviors such as fear of movement62.”

What the sources say

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In the paper

“state-based positive affect has been identified as a mediator of resilience in the wake of chronic pain 59–61.”

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In the paper

“There are strong prospective links between early-life traumatic experiences and the subsequent development of chronic pain 23, 24, 66–69.”

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In the paper

“In another study of patients with chronic pain, individuals assigned to tailored positive activities reported greater improvements in pain intensity and pain control compared to those in an active control condition 65.”

What the sources say

• Not checked yetcites [65] source

In the paper

“positive affect and optimism are associated with less pain and dysfunction 57, 58.”

What the sources say

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In the paper

“prospective studies suggest that pre-morbid psychological dysfunction represents a risk factor for the future development of numerous chronic pain conditions including musculoskeletal pain and functional pain disorders 14, 36–39.”

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In the paper

“Recent systematic reviews indicate that chronic pain patients, relative to pain-free controls, show elevations in all of these indices of self-reported negative affect 33–35.”

What the sources say

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In the paper

“That is, the psychological factor acts as a mediator (though not necessarily a causal mechanism) through which a treatment confers its benefits 30, 31.”

What the sources say

• Not checked yetcites [30] source
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In the paper

“abuse in childhood conferred a 97% increase in risk for having a painful somatic syndrome such as fibromyalgia in adulthood 23.”

What the sources say

• Not checked yetcites [23] source

In the paper

“Increasing evidence suggests an association between both psychological and physical trauma and chronic pain.”

In the paper

“emotional distress and psychosocial stress have been shown to increase the likelihood of transitioning from acute to chronic musculoskeletal pain 18, 36, 37, 41, 42.”

What the sources say

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In the paper

“there is a wealth of evidence that symptoms of depression, anxiety, and emotional distress contribute strongly (more strongly than pain intensity, in many studies) to key long-term outcomes of persistent pain such as physical disability 35, 43–46, work disability 47, healthcare costs 48, 49, mortality 50–53, and suicide 22, 54, 55.”

What the sources say

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In the paper

“Depression, anxiety, and general indices of emotional distress along with a cluster of negative emotions, thoughts, and behaviors termed, “negative affect,” are probably the most commonly-assessed psychological factors in patients with persistent pain 11, 32, 33.”

What the sources say

• Not checked yetcites [11] source
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In the paper

“In multivariate analyses, high pre-operative symptoms of depression remained the only significant predictor of failure to return to work after surgery, even in multivariate models with pre- and post-operative pain intensity included.”

What the sources say

• Not checked yetcites [56] source

In the paper

“In one study by Hausmann and colleagues 64, participants who were asked to complete positive activities (e.g., listing three good things about their day) reported improvements in pain scores from baseline to 6 months.”

What the sources say

• Not checked yetcites [64] source

In the paper

“There is preliminary evidence suggesting that PAIs can be effective in the treatment of chronic pain.”

In the paper

“childhood physical, sexual, and psychological abuse have all been demonstrated as risk factors for the development of chronic pain conditions in adulthood including fibromyalgia, irritable bowel syndrome, chronic pelvic pain, and temporomandibular joint disorders23, 69, 70.”

What the sources say

• Not checked yetcites [23] source
• Not checked yetcites [69] source
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In the paper

“in patients with low back pain, positive affect has been shown to buffer the effects of negative affect such that patients with high levels of both positive and negative affect reporting less pain and depression and better functioning than those with high levels of negative affect and low levels of positive affect 58.”

What the sources say

• Not checked yetcites [58] source

In the paper

“higher levels of pre-surgical emotional distress were associated with more postsurgical pain and impairment 20, 40.”

What the sources say

• Not checked yetcites [20] source
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In the paper

“In this study, depression fully mediated the prospective association between pain intensity and occupational disability.”

What the sources say

• Not checked yetcites [56] source

In the paper

“In a recent metaanalysis, the authors reported that the presence of past traumas is associated with a 2- to 3-fold increase in the development of chronic widespread pain23.”

What the sources say

• Not checked yetcites [23] source

In the paper

“Social forces also impact pain and pain-related outcomes.”

In the paper

“It is also associated with elevated pain severity and disability among abuse victims 73, 74.”

What the sources say

• Not checked yetcites [73] source
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In the paper

“parents’ reactions to children’s pain have also been shown to play an important determining role in children’s pain responses 110–114”

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In the paper

“PTSD symptoms have been shown to mediate the relationship between childhood abuse and maltreatment and pain and pain-related limitations later in life 75, 76.”

What the sources say

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In the paper

“the operant conditioning model of chronic pain posits that others’ responses to pain behavior play a role in chronic pain and disability 2, 105.”

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In the paper

“couples- based interventions for patients with painful cancers appear to show greater efficacy than either treatment as usual or exclusively patient-focused interventions 102–104”

What the sources say

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In the paper

“there is evidence to suggest some categories of traumatic stress are stronger risk factors for pain than others.”

In the paper

“social support may serve as a treatment target for chronic pain.”

In the paper

“it remains difficult to identify the degree to which PTSD and TBI can independently predict the development of chronic pain.”

In the paper

“there is considerable evidence that a higher degree of solicitousness in response to pain behaviors predicts increased pain-related disability 85, 106–108.”

What the sources say

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In the paper

“The social environment and interaction between social support and solicitousness may be particularly important for persons with acquired amputation during the first few months after the amputation.”

In the paper

“in adult veterans, combat exposure and post-traumatic stress disorder (PTSD) have been shown to have the strongest statistical association with chronic pain 23, 24.”

What the sources say

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In the paper

“better social support was associated with less postoperative pain after surgical management of breast cancer in a recent meta-analysis 97.”

What the sources say

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In the paper

“In a review of more than a dozen studies, the authors found that increased perceived social support was associated with better outcomes such as less pain and improved overall functioning among persons with pain and physical disability related to spinal cord injury, multiple sclerosis, and acquired amputation 85.”

What the sources say

• Not checked yetcites [85] source

In the paper

“The immediate social environment in the form of parents (for children experiencing pain) and spouses (for married adult patients with pain) exerts a powerful influence on pain-related outcomes.”

In the paper

“To date, most studies have focused on either perceived global social support (i.e., not pain-related) or solicitous social responses to pain behaviors (e.g., offering to take over tasks or encouragement to become less active) 85.”

What the sources say

• Not checked yetcites [85] source

In the paper

“social support is found to be associated with improved physical functioning for individuals with pain conditions 33, 87–89.”

What the sources say

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In the paper

“results of a 3-decade prospective study suggest the presence of PTSD symptoms amplify the predictive effect of child abuse on later-life pain outcomes 77.”

What the sources say

• Not checked yetcites [77] source

In the paper

“the presence of a supportive partner has been associated with reduced symptom burden (including less pain), improved quality of life, and fewer symptoms of distress in patients with chronic lymphocytic leukemia 92, metastatic breast cancer 93, 94, and other cancer types such as colorectal cancer95, 96.”

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In the paper

“individuals with childhood reports of distressing events such as hospitalizations or loss of a family member showed double the risk for the development of adult chronic pain even after adjusting for other important (and potentially confounding) predictors such as psychological distress and socioeconomic status 67”

What the sources say

• Not checked yetcites [67] source

In the paper

“a recent study revealed that depression was associated with patient-physician discordance in estimates of disease severity (i.e., depressed patients estimated their disease severity as much worse, on average, than their physicians did) 146.”

What the sources say

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In the paper

“Li and colleagues studied workplace support among arthritis patients; those who reported low workplace support were much more likely to develop depressive symptoms and work-related disability 18 months later 133.”

What the sources say

• Not checked yetcites [133] source

In the paper

“creating and sustaining an effective therapeutic alliance appears to be a necessary and sufficient condition for promoting the pain-improving effects of diverse interventions 144–145.”

What the sources say

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In the paper

“differing social and occupational structures across countries appear to contribute to cross-national differences in rates of return to work and occupational disability in the context of painful work injury.”

In the paper

“Anema and colleagues 134 compared sustainable return-to-work rates between 6 different countries and found that differences in job characteristics and social disability systems were more important than medical interventions, patient, and injury-related factors in explaining the large between-country differences in rates of return to work following painful occupational injuries.”

What the sources say

• Not checked yetcites [134] source

In the paper

“Patients’ attachment styles are also important predictors of pain-related outcomes among both children and adults.”

In the paper

“In cancer pain, social support interpersonal interaction preferences (e.g., discomfort with closeness and interdependence in relationships) seem to play an important role in shaping pain reports and general health 91.”

What the sources say

• Not checked yetcites [91] source

In the paper

“There is considerable evidence suggesting greater pain prevalence in women when compared to men 150, 152–154.”

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In the paper

“In a study of patients with chronic pain, social support in the form of encouragement to persist in a task was negatively associated with disability 135.”

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In the paper

“Sex and gender are important factors in the perception and experience of pain 148–151.”

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In the paper

“the social environment can also be harnessed for adaptive purposes.”

In the paper

“women demonstrate a greater sensitivity to multiple modalities of experimental pain when compared with men 161.”

What the sources say

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In the paper

“A handful of studies suggest that an index of the therapeutic relationship (i.e., the working alliance) statistically mediates the positive effects of rehabilitative treatments among people with musculoskeletal pain 141–145.”

What the sources say

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In the paper

“During psychotherapeutic treatment, for example, establishing a sound therapeutic relationship between patient and therapist is crucial for producing good outcomes 140.”

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In the paper

“It is clear that the interactions between patients with chronic pain and their significant others can either facilitate or impair adjustment to chronic pain 87, 120–122.”

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In the paper

“among couples, high levels of spousal depressive symptoms predict worsening patient disability and disease activity in patients with rheumatoid arthritis over a 1-year period 123.”

What the sources say

• Not checked yetcites [123] source

In the paper

“In a recent randomized controlled trial examining patients with LBP and their spouses, the spouse-assisted intervention produced larger decreases in fear of pain and catastrophizing than the standard multidisciplinary intervention 139.”

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• Not checked yetcites [139] source

In the paper

“Parental attention to pain and solicitous behaviors that encourage children to avoid regular activities may provide specific pathways by which parental catastrophizing amplifies a child’s pain experience and behavior 116–118, 119.”

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In the paper

“Patients with partners showing avoidant and anxious attachment styles are more likely to report increased pain and decreased well-being 103, 124–127.”

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In the paper

“there is consistent evidence to suggest hormones influence sex differences in clinical pain conditions.”

In the paper

“among individuals with depression, women are more likely to report pain complaints than men 213, 214”

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• Not checked yetcites [213] source
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In the paper

“compared to men, women have endorsed more frequent use of catastrophizing, behavioral activities, positive self-statements, social and emotional support, and problem-focused coping 148, 201–204.”

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In the paper

“catastrophizing has been shown to mediate the sex differences in pain-related outcomes, clinical pain, and experimental pain 162, 205, 206.”

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In the paper

“the severity of symptoms for several pain conditions including irritable bowel syndrome, temporomandibular disorders, headache, and fibromyalgia varies across the menstrual cycle 185–191.”

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In the paper

“Sex differences in pain perception can also be accounted for by a number of psychological factors including coping, catastrophizing, and affective distress.”

In the paper

“Although anxiety is more prevalent among females 209, 210”

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In the paper

“It is well-documented that, compared to White individuals, Black individuals demonstrate increased pain sensitivity.”

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In the paper

“A number of studies have demonstrated an association between endorsing masculinity and a higher pain threshold and tolerance and lower pain ratings 194–198.”

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In the paper

“Sex differences in the endogenous opioid system may also account for sex differences in the pain experience.”

In the paper

“Gender roles, for example, are associated with pain responses.”

In the paper

“and women with chronic pain are more likely to experience depression.”

What the sources say

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In the paper

“The sex differences observed in the pain experience may be caused by a number of biological, psychological, and sociocultural factors.”

In the paper

“However, a second subset of studies have found no sex differences in DNIC response 179–181.”

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In the paper

“Psychosocial mechanisms also contribute to the sex differences in the pain experience.”

In the paper

“There are also notable race differences in pain coping.”

What the sources say

• Not checked yetcites [247] source

In the paper

“Black individuals have reported higher levels of pain for clinical conditions such as AIDS, glaucoma, arthritis, post-operative pain, post-spinal fusion pain, and low back pain 216–220.”

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In the paper

“Preliminary evidence suggests that expectations for pain sensitivity and willingness to report pain differ based on race and ethnicity, which may help explain race difference in pain sensitivity 245, 246.”

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In the paper

“Native American participants in a laboratory pain study were actually less pain-sensitive than non- Hispanic Whites on measures of acute pain sensitivity”

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In the paper

“The meaning of pain (i.e. how individuals appraise pain) can be influenced by sociocultural factors and ethnic background 242, 243.”

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In the paper

“The differential experience of psychological distress may well contribute to race differences in pain sensitivity.”

In the paper

“Chronic socioeconomic strain and racism lead to high levels of sympathetic nervous system activation and physiological exhaustion making the individual more sensitive to painful stimuli 251.”

What the sources say

• Not checked yetcites [251] source

In the paper

“Racial differences in clinical and experimental pain sensitivity may be due to a variety of reasons including biological factors.”

In the paper

“In addition to biological factors, psychosocial factors may account for race differences in pain sensitivity.”

In the paper

“Black individuals experience reduced diffuse noxious inhibitory control (DNIC) of pain compared to non-Hispanic Whites, indicating ethnic differences in endogenous pain inhibition 229.”

What the sources say

• Not checked yetcites [229]

In the paper

“individual differences in the application of paincoping strategies have an important influence on pain-related outcomes.”

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In the paper

“In a recent meta-analysis, researchers found that Black Americans more frequently endorse the use of catastrophizing, hoping and praying, and passive coping compared to White Americans 247.”

What the sources say

• Not checked yetcites [247] source

In the paper

“Likewise, higher levels of anxiety are associated with increased pain sensitivity 236.”

What the sources say

• Not checked yetcites [236] source

In the paper

“Campbell and colleagues 228 found that compared to Caucasians, African Americans have a lower threshold for the nociceptive flexion reflex, a measurement of pain induced spinal reflexes.”

What the sources say

• Not checked yetcites [228] source

In the paper

“Differences in central pain-inhibitory mechanisms may also underlie racial differences in pain sensitivity.”

In the paper

“there is evidence to suggest that both catastrophizing as well as praying mediate race differences in experimental pain 162, 222.”

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In the paper

“Furthermore, these expectations decreased the activation of pain-related brain regions, offering an explanation of how expectations influence pain sensations.”

What the sources say

• Not checked yetcites [244] source

In the paper

“Koyama and colleagues 244 found that expectations of decreased pain reduced the subjective experience of pain.”

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• Not checked yetcites [244] source

In the paper

“Catastrophizing also impacts treatment effectiveness for pain-relieving interventions 300, 301, 309, including surgery310–312.”

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