The role of positive affect in pain and its treatment

Abstract

Objective: This narrative review summarizes and integrates the available literature on positive affect (PA) and pain to: (1) provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and pain; (2) provide a theoretical foundation from which to understand how PA operates in the context of chronic pain (CP); and (3) highlight how the prevailing psychosocial treatments for CP address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with CP.

Results: In experimental studies, the evidence suggests PA is analgesic. In clinical studies, the association of PA and pain is dynamic, time variant, and may be best considered in context of its interacting role with negative affect.

Discussion: We offer an "upward spiral" model of PA, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance CP self-management.

Figure 1. Hypothesized upward spiral model of positive affect, resilience and pain self-management

Interventions may ameliorate chronic pain and attendant negative affect (represented by progressively smaller pain and negative affect nodes as the spiral grows from bottom to top) by enhancing individual skills that promote positive affect. Such therapeutic processes may drive the upward spiral towards resilience and the ability to self-manage future pain flares by buffering individuals from the negative affective consequences of pain, decreasing pain sensitivity, and promoting prosocial behavior.