An Integrative Review of the Influence of Expectancies on Pain

Abstract

Expectancies can shape pain experiences. Attention for the influence of expectancies on pain has increased particularly due to research on placebo effects, of which expectancy is believed to be the core mechanism. In the current review, we provide a brief overview of the literature on the influence of expectancies on pain. We first discuss the central role of expectancy in the major psychological learning theories. Based on these theories, different kinds of expectancies can be distinguished. Pain experiences are influenced particularly by response expectancies directly pertaining to the pain experience itself, but can also be affected by self-efficacy expectancies regarding one's ability to cope with pain, and possibly by stimulus expectancies regarding external events. These different kinds of expectancies might interact with each other, and related emotions and cognitions, as reflected by various multifaceted constructs in which expectancies are incorporated. Optimism and pain catastrophizing, in particular, but also hope, trust, worry, and neuroticism have been found to be associated with pain outcomes. We conclude with recommendations for further advancing research on the influence of expectancies on pain and for harnessing expectancy effects in clinical practice.

Keywords: expectancy; hope; optimism; pain; pain catastrophizing; self-efficacy; trust; worry.

FIGURE 1

Schematic depiction of the influence of expectancies on pain, including the learning processes that influence these expectancies. Probable mediators and/or moderators are behavior, emotions, and cognitions. All elements in the model may also feed back to preceding elements.