Can positive affect attenuate (persistent) pain? State of the art and clinical implications.

PURPOSE OF REVIEW: Pain is an intense experience that can place a heavy burden on peoples' lives. The identification of psychosocial risk factors led to the development of effective pain treatments. However, effect sizes are modest. Accumulating evidence suggests that enhancing protective factors might also impact on (well-being despite) pain. Recent findings on positive affect (interventions) towards pain-related outcomes will be reviewed, and new avenues for treatment of persistent pain will be discussed. RECENT FINDINGS: Positive affect significantly attenuates the experience of pain in healthy and clinical populations. Positive affect interventions effectively reduce pain sensitivity and bolster well-being despite pain. Through both psychological and (neuro-)biological pathways, but also through its effect on central treatment processes such as inhibitory learning, positive affect can optimize the efficacy of existing treatments. Comprehensive understanding of the unique roles and dynamic interplay of positive and negative affect in moderating pain may optimize the treatment of (persistent) pain.

More optimism, less pain! The influence of generalized and pain-specific expectations on experienced cold-pressor pain.

Accumulating evidence suggests that dispositional optimism might be a protective factor against experiencing pain. The current paper presents two studies investigating the association between dispositional optimism and experimental pain. Moreover, the influence of pain-specific expectations on this association is investigated. In Study 1, mediation of pain-specific expectations in the relation between dispositional optimism and pain was hypothesized. Expected and experienced pain ratings were obtained from 66 healthy participants undergoing a cold pressor tolerance task. In Study 2, the moderating effect of dispositional optimism on the association between induced pain expectations and pain reports was studied in 60 healthy participants undergoing a 1-min cold pressor task. Both studies controlled for individual differences in fear of pain. Significant associations between dispositional optimism and pain ratings were found in both studies, although the exact time point of these associations differed. Subscale analyses revealed that only the pessimism subscale contributed significantly to these findings. We found no evidence for hypothesized mediation and moderation effects. Alternative explanations for the optimism-pain association are discussed.

General versus pain-specific cognitions: Pain catastrophizing but not optimism influences conditioned pain modulation.

BACKGROUND: Previous studies found evidence that dispositional optimism is related to lower pain sensitivity. Recent findings suggest that temporarily increasing optimism by means of imagining a positive future may also have pain-alleviating effects. OBJECTIVES: The present experiment was designed to investigate conditioned pain modulation (CPM) as a potential underlying mechanism of this pain-alleviating effect of induced optimism. METHODS: For this purpose, 45 healthy participants were randomized into an optimistic or neutral imagery condition. Additionally, participants completed questionnaires on dispositional optimism, pain catastrophizing and pain expectations. CPM was assessed by delivering a series of five heat pain stimuli on the nondominant hand before and during immersion of the dominant hand in water of 5°C for 70 s. RESULTS: A clear CPM effect was found, that is heat pain reports were lower during simultaneous cold water stimulation. Although the optimism manipulation successfully increased optimism, it did not affect pain ratings or CPM. Post hoc analyses indicated that dispositional optimism was not associated with the magnitude of CPM, but pain catastrophizing and pain expectations did significantly correlate with the CPM effect. CONCLUSION: Pain-specific but not general cognitions appear to influence endogenous pain modulation. SIGNIFICANCE: Conditioned pain modulation is not the underlying mechanism of the pain-alleviating effects of induced optimism. However, pain-specific cognitions including pain catastrophizing and pain expectations affect endogenous pain modulation which should be taken into account in treatment and CPM research.

Optimism lowers pain: evidence of the causal status and underlying mechanisms.

Previous studies have demonstrated a relation between dispositional optimism and lower pain sensitivity, but the causal status of this link remains unclear. This study sought to test the causal status by experimentally inducing a temporary optimistic state by means of writing about and visualizing a future best possible self. In addition, we explored pain expectations and (situational) pain catastrophizing as possible underlying mechanisms of the link between optimism and pain. Seventy-nine university students participated in a cold pressor task (CPT). Before the CPT, half of them received the optimism manipulation and the other half a control manipulation. Induced optimism was related to lower pain intensity ratings during the CPT compared to the control group, thereby experimentally confirming causality. This effect was not explained by pain-related expectations about the task. Situational pain catastrophizing, however, did seem to mediate the relation between optimism and pain. This study is novel in that it confirms the causal status of optimism towards pain. Additionally, the results reveal that positive interventions might provide a useful alternative in reducing pain catastrophizing as an extremely relevant target in pain treatment.

Especificidad de una intervención sobre el Mejor Self Posible para incrementar el optimismo: Comparación con una intervención de gratitud / Specificity of the Best Possible Self intervention for increasing optimism: Comparison with a gratitude intervention

The present study compared the effects of a one week best possible self intervention and a one week gratitude intervention on life satisfaction and optimism. We hypothesized that both interventions would lead to similar increases in life satisfaction, but that only the best possible self intervention would increase optimism. The results partly confirmed the hypotheses: only the best possible self intervention led to increased optimism immediately after the intervention period, which further increased one week after completion of the intervention. However, the best possible self intervention was also more effective in increasing life satisfaction than the gratitude intervention. Whereas the increase in life satisfaction in the best possible self intervention was significantly different from the control intervention, this was not the case in the gratitude condition. We conclude that the best possible self intervention is an effective exercise if one aims to increase optimism.

El presente estudio comparó los efectos en satisfacción vital y optimismo de dos intervenciones (mejor self posible y gratitud), de una semana de duración. Hipotetizamos que ambas intervenciones incrementarían la satisfacción vital pero que la intervención del mejor self possible sería mejor para incrementar el optimismo. Los resultados confirmaron las hipótesis: sólo la intervención del mejor self posible condujo a un incremento en optimismo, que incluso se incrementó una semana después de la intervención. Sin embargo, la intervención del mejor self posible también fue más efectiva que la intervención en gratitud para incrementar la satisfacción vital. Mientras que el aumento en la satisfacción vital en la intervención del mejor self posible fue significativamente mayor que en el grupo de control, no sucedió lo mismo en la condición de gratitud. Concluimos que la intervención del mejor self posible es un ejercicio útil si se pretende incrementar el optimismo.