Positive affect could reduce the impact of pain
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Silje Endresen Reme
In this issue of the Scandinavian Journal of Pain, Thong and coworkers investigate the buffering role of positive affect on the association between pain and pain-related outcomes [1]. Through a study of 101 patients with back or knee pain, they were able to demonstrate that more positive affect weakened the association between pain intensity, negative affect, and depression. Could positive affect be an unrecognized way to reduce the impact of pain for the individual chronic pain sufferer?
1 Target the consequences of chronic pain, not the pain itself
Chronic pain is often associated with negative affect in various types and forms, the most commonly reported being depression [2]. Furthermore, the consequences of pain may for many patients be a bigger burden than the pain itself. Qualitative studies lend support to this notion. In a recent phenomenological study the patients emphasized that it was not the physical pain itself but the psychosocial consequences – distress, loneliness, lost identity, and low quality of life – that bothered them the most [3]. If these reports are representative for the large group of chronic pain sufferers, larger efforts should be directed towards limiting the consequences of pain rather than trying to reduce the pain itself in patients with chronic pain. The paper by Thong and coworkers is a direct response to this gap through their demonstration of positive affect as a way to buffer the negative consequences of pain.
2 From pathogenesis to salutogenesis
Positive affect may be an undervalued asset in both pain rehabilitation and pain self-management. Although most clinical approaches aim to enhance positive affect indirectly, few treatments target positive affect directly. The most frequently used treatments in medicine and rehabilitation are based on a pathology model, where focus lies on reducing symptoms and alleviate pain. A different perspective has, however, been proposed based on Antonovsky’s earlier writings, resulting in the salutogenic model [4]. Here, focus is targeted towards tracing the origins of health and well-being rather than the causes of illness and disease. A similar theoretical perspective is offered by Thong and coworkers and involves Fredrickson’s broaden-and-build theory, where positive affect is assumed to build enduring personal resources that can function as reserves to be drawn on later to manage future threats[5].
3 Facilitating positive affect
The study has some limitations that the authors themselves fully acknowledge. First and foremost, the study population is relatively small and based on a convenience sample, thus limiting generalizability to larger groups of people with chronic pain. Further, the cross sectional nature of the data precludes any causal conclusions about the associations. The study therefor needs replications, both within the same patient group, but also across other groups of pain patients.
Nevertheless, if the findings are replicated, they entail important clinical implications. If positive affect is indeed a significant buffer between pain and pain-related outcomes, amplifying and facilitating positive affect in pain patients could be one way to improve the lives of the millions of people suffering from chronic pain. It could also open up for more “positive psychology” oriented interventions in the treatment of chronic pain, which inherently has a larger focus on the enhancement of positive affect. Clearly, we should not settle with the current psychosocial pain treatments, given the modest effect sizes produced by them [6]. A shift in perspective appears to be needed, and the one offered by Thong and coworkers could be a significant avenue to explore further.
In conclusion, the paper offers new insights about the buffering role of positive affect on pain-related outcomes. If the findings hold true in future replications, they clearly should result in clinical implications such as targeting positive affect to a larger degree in pain self-management and pain rehabilitation.
DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.09.008
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Conflict of interest
Conflict of interest Statement: None declared.
References
[1] Thong ISK, Tan G, Jensen MP. The buffering role of positive affect on the association between pain intensity and pain related outcomes. Scand J Pain 2017;14:91–7.Suche in Google Scholar
[2] Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13:116–37.Suche in Google Scholar
[3] Ojala T, Hakkinen A, Karppinen J, Sipila K, Suutama T, Piirainen A. Chronic pain affects the whole person – a phenomenological study. Disabil Rehabil 2015;37:363–71.Suche in Google Scholar
[4] Antonovsky A. Health stress and coping. San Francisco: Jossey-Bass Publishers; 1979.Suche in Google Scholar
[5] Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol 2001;56: 218–26.Suche in Google Scholar
[6] Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012;11:pCd007407.Suche in Google Scholar
© 2016 Scandinavian Association for the Study of Pain
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Artikel in diesem Heft
- Scandinavian Journal of Pain
- Editorial comment
- Patients with chronic neck-pain after trauma do not differ in type of symptoms and signs, but suffer more than patients with chronic neck pain without a traumatic onset
- Observational study
- Chronic neck pain patients with traumatic or non-traumatic onset: Differences in characteristics. A cross-sectional study
- Editorial Comment
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- Original experimental
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- Editorial comment
- Objective methods for the assessment of the spinal and supraspinal effects of opioids
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- Editorial Comment
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- Original experimental
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