Negative, but not positive, expectancies predict 10-year changes in pain outcomes for older adults with pain

Previous research suggests that positive expectancies are associated with adaptive pain outcomes and negative expectancies are associated with maladaptive pain outcomes in individuals with chronic pain both cross-sectionally and longitudinally. However, it is unclear whether positive and negative expectancies 1) uniquely predict pain outcomes and 2) predict long-term changes in pain outcomes. The aim of this study was to examine how shared and unique aspects of positive and negative expectancies differentially predicted 10-year changes in pain and commonly associated outcomes (i.e., pain severity, pain interference, functional limitations, and depressive symptoms) for older adults with pain. Older adults with pain (N = 5829) were sampled from a nationally representative, longitudinal dataset (Health and Retirement Study). First, confirmatory factor analyses (CFA) determined appropriate modeling of expectancy variables. Then, mixed latent- and measured-variable path analyses examined the unique relationships between expectancy variables and changes in pain outcomes across 10 years. CFAs found that measures of optimism and hopelessness were best modeled in terms of their valence, as positive or negative expectancies. Path analyses revealed that negative, but not positive, expectancies were significantly associated with worsening pain severity (ß =.15, p <.001), pain interference (ß =.14, p <.001), functional limitations (ß =.09, p <.001), and depressive symptoms (ß =.13, p <.001) across a 10-year period. Findings suggest that negative expectancies uniquely predict worsening severity of pain-related outcomes compared to positive expectancies. Negative expectancies may be an appropriate clinical target for mitigating worsening pain trajectories over time. PERSPECTIVE: This article found that only negative - not positive - expectancies predicted 10-year changes in pain severity, pain interference, functional limitations, and depressive symptoms in a nationally representative sample of older adults with pain. Negative expectancies may be an optimal clinical target for improving long-term pain outcomes in older adults.