Dynamic pain–emotion relations in chronic pain: a theoretical review of moderation studies

Abstract

Running head: DYNAMIC PAIN-EMOTION RELATIONS 2Current developments in chronic pain research are changing the focus in the study of pain-emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra-and interpersonal levels has significant clinical implications for psychological adjustment to chronic pain conditions, and thus represents an important topic for both clinical and health psychology. The present article reviews the existing theoretical explanations of these dynamics and their emerging empirical support, and suggests further areas of investigation. A literature search identified research on moderators of pain-emotion relations in chronic pain; existing theories were also examined from this perspective.A theoretical analysis revealed several important contributions, including the concepts of affect differentiation, generalized discrimination ability, resilience, vulnerability, coping, emotion regulation and desynchrony, which are described here together with the relevant empirical research and clinical implications. Important areas for development are the clarification of the common elements and opposing predictions and the empirical examination of mediating mechanisms. Several methodological issues are discussed. This review identifies a rich theoretical basis for research into pain-emotion moderation, and suggests that further examinations of such relationships might hold important clinical consequences. ; moderation; chronic pain; pain-affect Running head: DYNAMIC PAIN-EMOTION RELATIONS 3 In comparison to other health conditions, chronic pain is a special case, in that its main symptom, pain itself, is simultaneously a sensory and emotional experience. Keywords: pain; emotionTherefore, understanding the role of emotion in pain is central to our efforts of improving psychosocial adjustment to chronic pain. Moreover, since pain is a prevalent symptom in most health complaints, the study of pain-emotion relations can be considered a topic of strategic interest to health psychologists. However, chronic pain research and pain management interventions have focused predominantly on cognition and behaviour, and by comparison our understanding of emotion is still incipient. Although numerous studies have tackled pain-emotion relations from different perspectives, a coherent image is yet to emerge. The present review attempts to bring together various theoretical contributions in an effort to clarify one important aspect of this relationship: its dynamic quality, as shown by the increasing number of studies reporting moderating factors for pain-emotion relations. Thus, our review aims also to contribute to the current shift from solely cognitive and behavioural models towards recognising the contribution of emotion in chronic pain management.Emotion has been studied from various perspectives in chronic pain research.In the study of pain perceptio...

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