Positive affect and chronic pain: a preregistered systematic review and meta-analysis

Area of Science:

• Psychology
• Pain Management
• Public Health

Background:

• Chronic noncancer pain (CNCP) affects many adults, posing a significant health burden.
• Current behavioral therapies for CNCP primarily target negative affect (NA) with limited success.
• The role of positive affect (PA) in modulating CNCP severity remains underexplored.

Purpose of the Study:

• To systematically review and investigate the association between positive affect (PA) and pain severity in adults with CNCP.
• To synthesize evidence from diverse study designs regarding the PA-CNCP relationship.
• To explore factors influencing the PA-CNCP association through subgroup analyses.

Main Methods:

• Systematic literature search across multiple databases (PubMed, PsycINFO, CINAHL, etc.) up to July 2019.
• Meta-analysis of 29 studies involving 3521 participants with CNCP (pain duration ≥ 12 weeks).
• Inclusion of observational, experimental, and intervention studies reporting quantitative outcomes; risk of bias assessment performed.

Main Results:

• A significant inverse association was found between PA and pain severity in CNCP patients (r = -0.23).
• Subgroup analyses revealed significant effects for gender and marginally significant effects for age, particularly in studies adjusting for NA.
• Observational studies showed larger effect sizes with higher female proportions and when NA was not adjusted; intervention studies had larger effects in older samples.

Conclusions:

• Positive affect (PA) demonstrates an inverse relationship with pain severity in individuals experiencing chronic noncancer pain (CNCP).
• PA represents a potential therapeutic target for improving CNCP management, complementing existing strategies focused on negative affect.
• Factors such as gender, age, and adjustment for negative affect influence the observed association between PA and CNCP severity.