The role of affect in chronic pain: A systematic review of within-person symptom dynamics

Abstract

Objective: Chronic pain is conceptualized as a biopsychosocial phenomenon that involves both physical and emotional processes. The vast majority of research regarding these facets of chronic pain characterizes differences between individuals. In this review, we describe problems with assuming that differences between persons accurately characterize within-person processes. We also provide a systematic review of studies that have examined within-person relationships between pain and affect among individuals with chronic pain.Method: Articles published by December 2020 that pertained to within-person assessment of pain and emotion, affect, or mood were identified. Data regarding study design, adherence, and concurrent and prospective relationships among pain and affect variables were extracted and summarized.Results: Of 611 abstracts, 55 studies met inclusion criteria. Results suggest that individuals with chronic pain tend to experience increased negative affect and decreased positive affect when experiencing more severe pain (rpooled = .18 and -.19, respectively). However, the size of these effects appeared smaller than between-person associations, and there was evidence of significant variability between individuals. Examination of predictive relationships between pain and affect largely suggested the tendency of symptoms to predict themselves, rather than pain predicting affect or vice versa.Conclusions: Consistent with group-level relationships, experiencing more severe pain relative to an individual's average seems to be associated with more negative affect and less positive affect.However, individuals vary in the size and even direction of these effects. More research is necessary to understand the implications of such variability for the assessment and treatment of chronic pain.

Establishing the Reliability, Validity, and Prognostic Utility of the Momentary Pain Catastrophizing Scale for Use in Ecological Momentary Assessment Research

“…Ecological momentary assessment and experience sampling are becoming increasingly popular methods for assessing dynamic processes related to pain [18][19][20] . However, there is a dearth of measures that have been psychometrically validated for this purpose.…”

“…In this case, if pain catastrophizing is only assessed once per day via the daily PCS, then we may miss important effects of pain catastrophizing on other painrelated variables that occur on the order of seconds, minutes, or hours. For this reason, many recent studies of pain and related variables have opted for Ecological Momentary Assessment (EMA) or Experience Sampling Methodology (ESM) designs wherein participants are sampled multiple times per day [18][19][20] .…”

Establishing the Reliability, Validity, and Prognostic Utility of the Momentary Pain Catastrophizing Scale for use in Ecological Momentary Assessment Research

“…Ecological momentary assessment and experience sampling are becoming increasingly popular methods for assessing dynamic processes related to pain [12][13][14] . However, there is a dearth of measures that have been psychometrically validated for this purpose.…”

“…In this case, if pain catastrophizing is only assessed once per day via the daily PCS, then we may miss important effects of pain catastrophizing on other painrelated variables that occur on the order of seconds, minutes, or hours. For this reason, many recent studies of pain and related variables have opted for Ecological Momentary Assessment (EMA) or Experience Sampling Methodology (ESM) designs wherein participants are sampled multiple times per day [12][13][14] .…”

Implications for a mindfulness-enhanced positive affect induction: A brief commentary toward acute pain management

“…Given the evidence upholding mindfulness and positive affect in pain management, a brief technique based on Finan and Garland’s (2015) model is ripe for future research and has implications for bolstered acute pain management, as well as addressing risks and obstacles with opioid-based post-surgical pain management and subsequent tapering (Acevedo et al, 2022; Addington et al, 2020; Amanullah et al, 2021; Ashar et al, 2022; Frumkin and Rodebaugh, 2021; Geers et al, 2019; McPhee and Graven-Nielsen, 2022). As noted above, current techniques can take weeks or months of guided practice for efficacy and thus may be improved by a focus on arousing strong positive affect.…”