The effect of induced optimism on early pain processing: indication by contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR).

Situationally induced optimism has been shown to influence several components of experimental pain. The aim of the present study was to enlarge these findings for the first time to the earliest components of the pain response by measuring contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR). Forty-seven healthy participants underwent two blocks of phasic thermal stimulation. CHEPs, the SSR and self-report pain ratings were recorded. Between the blocks of stimulation, the 'Best Possible Self' imagery and writing task was performed to induce situational optimism. The optimism manipulation was successful in increasing state optimism. It did, however, neither affect pain-evoked potentials nor the SSR nor self-report pain ratings. These results suggest that optimism does not alter early responses to pain. The higher-level cognitive processes involved in optimistic thinking might only act on later stages of pain processing. Therefore, more research is needed targeting different time frames of stimulus processing and response measures for early and late pain processing in parallel.

Shifting the perspective: how positive thinking can help diminish the negative effects of pain.

OBJECTIVES: The field of pain psychology has taken significant steps forward during the last decades and the way we think about how to treat chronic pain has radically shifted from a biomedical perspective to a biopsychosocial model. This change in perspective has led to a surge of accumulating research showing the importance of psychological factors as determinants for debilitating pain. Vulnerability factors, such as pain-related fear, pain catastrophizing and escape/avoidant behaviours may increase the risk of disability. As a result, psychological treatment that has emerged from this line of thinking has mainly focused on preventing and decreasing the adverse impact of chronic pain by reducing these negative vulnerability factors. Recently, another shift in thinking has emerged due to the field of positive psychology, which aims to have a more complete and balanced scientific understanding of the human experience, by abandoning the exclusive focus on vulnerability factors towards including protective factors. METHODS: The authors have summarised and reflected on the current state-of-the-art of pain psychology from a positive psychology perspective. RESULTS: Optimism is an important factor that may in fact buffer and protect against pain chronicity and disability. Resulting treatment approaches from a positive psychology perspective are aimed at increasing protective factors, such as optimism, to increase resilience towards the negative effects of pain. CONCLUSIONS: We propose that the way forward in pain research and treatment is the inclusion of both vulnerability and protective factors. Both have unique roles in modulating the experience of pain, a finding that had been neglected for too long. Positive thinking and pursuing valued goals can make one's life gratifying and fulfilling, despite experiencing chronic pain.

The effectiveness and equivalence of different versions of a brief online Best Possible Self (BPS) manipulation to temporary increase optimism and affect.

BACKGROUND AND OBJECTIVES: The Best Possible Self (BPS) has been found to be an effective manipulation to temporarily improve optimism and affect. The BPS has been used in different formats. In some versions, participants just write about their best possible future, while in others this is combined with imagery. An imagery only version has not been tested yet. The aim of the current study was to examine the effectiveness of three different versions of the BPS and their equivalence in improving optimism and affect. METHODS: In an online study format, participants (N = 141) were randomly assigned to one of four conditions: (1) writing and imagery BPS; (2) writing BPS; (3) imagery BPS; and (4) a typical day (TD) control condition. RESULTS: Results showed that each BPS condition significantly improved optimism (i.e. increased positive future expectancies and decreased negative future expectancies) and affect (i.e. increased positive affect and decreased negative affect). Equivalence testing showed that all online BPS conditions were equivalent in increasing optimism and affect, thereby confirming that both the writing and imagery elements of the BPS can independently from each other increase optimism and positive affect in a healthy population. LIMITATIONS: Only the immediate effects of the BPS formats on increasing optimism and affect were measured. CONCLUSIONS: The BPS manipulation can be employed in different ways for potential future exploration, depending on the research question, design and context and/or E-mental health applications for the treatment of individuals suffering from psychological complaints.

The effect of perioperative psychological interventions on persistent pain, disability, and quality of life in patients undergoing spinal fusion: a systematic review.

PURPOSE: Patients undergoing spinal fusion are prone to develop persisting spinal pain that may be related to pre-existent psychological factors. The aim of this review was to summarize the existing evidence about perioperative psychological interventions and to analyze their effect on postoperative pain, disability, and quality of life in adult patients undergoing complex surgery for spinal disorders. Studies investigating any kind of psychological intervention explicitly targeting patients undergoing a surgical fusion on the spine were included. METHODS: We included articles that analyzed the effects of perioperative psychological interventions on either pain, disability, and/or quality of life in adult patients with a primary diagnosis of degenerative or neoplastic spinal disease, undergoing surgical fusion of the spine. We focused on interventions that had a clearly defined psychological component. Two independent reviewers used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to perform a systematic review on different databases. Risk of bias was evaluated using the Downs and Black checklist. Given study differences in outcome measures and interventions administered, a meta-analysis was not performed. Instead, a qualitative synthesis of main results of included papers was obtained. RESULTS: Thirteen studies, conducted between 2004 and 2017, were included. The majority were randomized-controlled trials (85%) and most patients underwent lumbar fusion (92%). Cognitive behavioral therapy (CBT) was used in nine studies (69%). CBT in the perioperative period may lead to a postoperative reduction in pain and disability in the short-term follow-up compared to care as usual. There was less evidence for an additional effect of CBT at intermediate and long-term follow-up. CONCLUSION: The existing evidence suggests that a reduction in pain and disability in the short-term, starting from immediately after surgery to 3 months, is likely to be obtained when a CBT approach is used. However, there is inconclusive evidence regarding the long-term effect of a perioperative psychological intervention after spinal fusion surgery. Further research is necessary to better define the frequency, intensity, and timing of such an approach in relation to the surgical intervention, to be able to maximize its effect and be beneficial to patients.

The Effect of Induced Optimism on Situational Pain Catastrophizing.

Background: There is broad evidence that optimism is associated with less pain, while pain catastrophizing leads to increased pain. The aim of this study was to examine whether experimentally induced optimism can reduce situational pain catastrophizing and whether this relation is moderated by dispositional optimism and/or dispositional pain catastrophizing. Methods: Situational pain catastrophizing during two thermal stimulations was measured in 40 healthy participants with the Situational Catastrophizing Questionnaire (SCQ). Between the two stimulations, the Best Possible Self (BPS) imagery and writing task was performed to induce situational optimism in the experimental group while the control group wrote about their typical day. Questionnaires were administered to assess dispositional optimism [Life Orientation Test-Revised (LOT-R)] and dispositional pain catastrophizing [Pain Catastrophizing Scale (PCS)]. Results: There was a significant interaction between the optimism induction and trait pain catastrophizing: the association of trait pain catastrophizing with state pain catastrophizing was weakened after the optimism induction. No overall effect of induced optimism on situational pain catastrophizing and no significant moderating influence of trait optimism were found. Conclusion: The state optimism induction apparently counteracted the manifestation of dispositional pain catastrophizing as situational pain catastrophizing. This implies that high trait pain catastrophizers may have especially benefitted from the optimism induction, which is in line with resilience models stressing the buffering role of optimism.

Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials.

ABSTRACT: Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic postsurgical pain (CPSP). Therefore, the question arises whether targeting these psychological factors can reduce negative postsurgical outcomes. The aim of the current review was to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute postsurgical pain and CPSP and disability in adults. Randomized controlled trials were identified through 4 databases (Web of Science, PsychINFO, PubMed, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). The outcomes of interest were (sub)acute (ie, within 3 months after surgery) and chronic (>3 months after surgery) pain and disability. After screening, 21 studies were included in the final analyses. It was found that psychological interventions significantly reduced (sub)acute pain (d = -0.26, 95% confidence interval [CI] [-0.48 to -0.04]) and disability (d = -0.43, 95% CI [-0.84 to -0.03]) as well as CPSP (d = -0.33, 95% CI [-0.61 to -0.06]) and disability (d = -0.43, 95% CI [-0.68 to -0.18]). In addition, interventions delivered after surgery and interventions delivered by a psychologist tended to be more effective than interventions delivered before surgery and interventions delivered by another healthcare provider. Furthermore, the current review points to the need for more research to determine which specific type of intervention may be most beneficial for surgical patients. Finally, the current review identified that research in this domain has concerns regarding bias in missing outcome data due to withdrawal and drop out.

Healthcare use during COVID-19 and the effect on psychological distress in patients with chronic cardiopulmonary disorders in the Netherlands: a cross-sectional study.

OBJECTIVES: The COVID-19 pandemic caused a massive shift in the focus of healthcare. Such changes could have affected health status and mental health in vulnerable patient groups. We aimed to investigate whether patients with chronic pulmonary and cardiac diseases had experienced high levels of psychological distress during the COVID-19 pandemic in the Netherlands. DESIGN: A cross-sectional study. SETTING: COVID-19 pandemic-related changes in healthcare use, health status and psychological distress were investigated among patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF) and congestive heart failure (CHF), using an online nationwide survey. PARTICIPANTS: 680 patients completed the survey. COPD was the most often reported diagnosis 334 (49%), followed by congestive heart failure 219 (32%) and PF 44 (7%). There were 79 (12%) patients with primary diagnosis 'other' than chronic cardiopulmonary disease, who also completed this survey. INTERVENTIONS: Psychological distress was assessed via the DASS-21 score (Depression Anxiety Stress Scale). Moreover, specific worries and anxieties regarding COVID-19 were explored. RESULTS: The frequency of contact with healthcare professionals changed in 52%. Changes in treatment were reported in 52%. Deterioration in health status was self-reported in 39%. Moderate to extremely severe levels of depression, anxiety and stress was observed in 25.8%, 28.5% and 14%, respectively. Over 70% reported specific worries and anxieties, such as about their own health and fear of being alone. Both the deterioration in health status and increased levels of anxiety were significantly (p<0.001, p<0.006) associated with changes in treatment. Exploratory analyses indicated that lack of social support may further increase anxiety. CONCLUSION: Healthcare use changed during the COVID-19 pandemic in the Netherlands. It was associated with a decrease in health status, and increased psychological stress among patients with chronic cardiopulmonary disorders. Provision of healthcare should be more sensitive to the mental health needs of these patients during subsequent COVID-19 waves.

Imagining a positive future reduces cortisol response to awakening and reactivity to acute stress.

The positive influence of optimism on health is thought to be due in part to a reduced physiological response to stress, as manifested for instance in activity of hypothalamic-pituitary-adrenal (HPA) systems. Results of previous studies support the notion that dispositional optimism can influence diurnal cortisol secretion as well as cortisol reactivity. The aim of the present study was to examine whether induced optimism can similarly affect HPA activity and thereby potentially have beneficial health effects. We assigned 66 university students to either the Best Possible Self (BPS) or an active control condition, respectively entailing two weeks of daily visualization of a positive future or time management exercises. Before and after the intervention, we assessed diurnal cortisol levels, response to awakening (CAR), and reactivity to the Trier Social Stress Task (TSST), as well as optimism, affect, negative cognitions, perceived stress, and threat appraisal. Effects of the BPS intervention were tested with repeated measures ANOVA (psychological outcomes) and multilevel regression (cortisol outcomes). The BPS intervention was associated with decreases in both the CAR and cortisol responses to acute stress. Compared to controls, BPS participants showed decreased worrying and increased positive affect post-intervention; however, they did not show the expected greater increase in optimism. Within-person decreases in worrying were associated with decreased CARs, whereas both decreased worrying and increased PA were linked to attenuated stress reactivity. Results suggest that the BPS intervention can influence HPA axis reactivity, with effects on well-being variables likely mediating the process. More research is needed to determine longer-term neuroendocrine and health effects of such interventions in at-risk as well as healthy populations.

Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain.

PURPOSE: The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily functioning, pain-related impairment, and psychological well-being). METHODS: The sample comprised 258 individuals with chronic musculoskeletal pain who completed a series of questionnaires and vignettes. The vignettes presented a short description of a situation in which a person with chronic pain experienced a threat to a valued domain-specific goal and had to choose a possible goal management solution (i.e., goal persistence, flexibility reengagement, and disengagement). Hierarchical regression analyses were used to predict chronic pain adaptation using the selected vignette strategies as predictors. RESULTS: After controlling for age, sex, pain intensity, and the responses to the dispositional goal management scales, persistence, reengagement, and disengagement goal strategies presented in the case scenarios predicted daily functioning (p < .001). Persistence, flexibility, disengagement (p < .001), and reengagement (p < .05) predicted pain-related impairment. Persistence, disengagement (p < .001), and flexibility (p < .05) predicted psychological well-being scores. CONCLUSION: The use of vignettes could be useful to assess goal adjustment because this methodology enables respondents to provide more context-specific responses. The results of this approach could be used to improve clinical practice aimed at helping people with chronic musculoskeletal pain to better cope with this health condition.

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.

Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery.

OBJECTIVES: The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. METHODS: In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. RESULTS: Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. DISCUSSION: Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

More than my RA: A randomized trial investigating body image improvement among women with rheumatoid arthritis using a functionality-focused intervention program.

OBJECTIVE: Negative body image is prevalent in women with rheumatoid arthritis and can affect other areas of well-being. Patients have expressed desire for body image to be addressed in treatment. Yet, it is not routinely addressed and no experimental intervention research has been conducted, until now. This randomized trial evaluated a brief online body image intervention for women with rheumatoid arthritis, with a focus on body functionality (everything the body is capable of doing) as the primary technique. METHOD: Women with rheumatoid arthritis and who wanted to feel better about their body (N = 84; Mage = 44.82) were randomized to the Expand Your Horizon intervention (comprising 3 writing exercises focusing on body functionality) or a waitlist control group. Primary outcomes concerned body image and secondary outcomes related to rheumatoid arthritis; these outcomes were assessed at pretest, posttest, and at 1-week and 1-month follow-up. RESULTS: Multilevel modeling analyses showed that, relative to control, participants in the intervention experienced improvements in various aspects of body image (functionality appreciation, body appreciation, body satisfaction, body-self alienation) and decreases in depression, with effects persisting at 1-week and 1-month follow-up. No intervention effects were found for body-self harmony, rheumatoid arthritis-specific disability, pain-related disability, and anxiety. CONCLUSIONS: Focusing on body functionality can improve body image and reduce depression in women with rheumatoid arthritis. The intervention technique is easy and affordable to deliver and could be a fruitful addition to extant treatments for rheumatoid arthritis. (PsycINFO Database Record

Optimism, Positive and Negative Affect, and Goal Adjustment Strategies: Their Relationship to Activity Patterns in Patients with Chronic Musculoskeletal Pain.

Objective: Activity patterns are the product of pain and of the self-regulation of current goals in the context of pain. The aim of this study was to investigate the association between goal management strategies and activity patterns while taking into account the role of optimism/pessimism and positive/negative affect. Methods: Two hundred and thirty-seven patients with chronic musculoskeletal pain filled out questionnaires on optimism, positive and negative affect, pain intensity, and the activity patterns they employed in dealing with their pain. Questionnaires were also administered to assess their general goal management strategies: goal persistence, flexible goal adjustment, and disengagement and reengagement with goals. Results: Structural equation modelling showed that higher levels of optimism were related to persistence, flexible goal management, and commitment to new goals. These strategies were associated with higher positive affect, persistence in finishing tasks despite pain, and infrequent avoidance behaviour in the presence or anticipation of pain. Conclusions: The strategies used by the patients with chronic musculoskeletal pain to manage their life goals are related to their activity patterns.

Pain, Please: An Investigation of Sampling Bias in Pain Research.

Experimental pain research frequently relies on the recruitment of volunteers. However, because experimental pain research often involves unpleasant and painful sensations, it may be especially susceptible to sampling bias. That is, volunteers in experimental pain research might differ from nonvolunteers on several relevant variables that could affect the generalizability and external validity of the research. We conducted 2 studies to investigate potential sampling bias in experimental pain research. In study 1 we assessed participants' (N = 275; age = 17-30 years) perceived likelihood of participating in pain research. Pain catastrophizing, fear of pain, illness and injury sensitivity, depression, anxiety, sensation-seeking, gender identity, body appreciation, and social desirability were also assessed as potential predictors of the likelihood to participate. In study 2, participants (N = 87; Age = 18-31 years) could sign up for 2 nearly identical studies, with only one involving painful sensations. Thirty-six participants signed up for the pain study and 51 participants signed up for the no-pain study. Study 1 showed that lower levels of fear of pain, higher levels of sensation-seeking, and older age predicted the perceived likelihood of participating in pain research. Study 2 showed significantly higher levels of sensation-seeking in participants who signed up for the pain study compared with those who signed up for the no-pain study. The implications of these findings for future research, as well as the clinical conclusions on the basis of experimental pain research, are discussed. PERSPECTIVE: Intention to participate in experimental pain research was associated with less fear of pain, higher sensation-seeking, and older age. Actual participation in experimental pain research was associated with higher sensation-seeking. This potential sampling bias in studies involving painful stimuli could limit external validity and generalizability of pain research.

The effect of Mindfulness-Based Stress Reduction on wound healing: a preliminary study.

Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing. Trial Registration NTR3652, http://www.trialregister.nl.

The course of fear of cancer recurrence: Different patterns by age in breast cancer survivors.

OBJECTIVE: To examine the time course and predictors of fear of cancer recurrence (FCR) in breast cancer survivors over a period of 18 months after initial surgery. METHODS: Breast cancer patients (n = 267) were followed until 18 months after primary breast surgery. Shortly after surgery, participants completed the Life Orientation Test-Revised to measure optimism and the Concerns about Recurrence Scale to measure FCR. Mixed regression analysis was performed with age, optimism, marital status, education, type of surgery, with or without lymphectomy, chemotherapy, hormonal therapy, or radiotherapy, time since surgery, and all interactions with time as predictors of FCR. RESULTS: The final model included a significant interaction between age and time since surgery and a main effect for optimism. CONCLUSION: These results suggest that the course of FCR depends on the age of breast cancer survivors. Younger survivors showed an increase of fear during the first 1.5 years after breast surgery, whereas older survivors showed stable levels during the first 6 months after which it declined. Also, less optimistic survivors reported higher levels of FCR. Health care providers should pay (extra) attention to FCR in younger and less optimistic patients and offer psychological help when needed.

Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study.

BACKGROUND: Good adherence to prescribed analgesics can be crucial to suppress or even prevent acute postoperative pain after day surgery. The aim of this study was to analyze prevalence and predictors of analgesic nonadherence after day surgery. METHODS: Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. The primary outcome parameter was analgesic nonadherence. Adherence was defined according to the patient's response to the questionnaire item "analgesia use as prescribed": full adherence, "yes"; partial adherence, "yes, sometimes"; nonadherence, "no." Bivariate and multivariate logistic regression analyses were performed to identify predictors of analgesic nonadherence. RESULTS: A total of 1,248 patients were included. The prevalence rates of analgesic nonadherence and partial adherence were 21.6% and 20.0%, respectively, in the total study population but dropped to 9.4% and 19.8%, respectively, in patients with moderate to severe pain. Low postoperative pain intensity and short duration of surgery were the most important predictors of analgesic nonadherence. The most important preoperative predictors for analgesic nonadherence were low preoperative pain intensity, low preoperative expectations of pain, and low fear of short-term effects of surgery. CONCLUSION: Analgesic nonadherence and partial adherence are common after day surgery but decrease as average pain intensity increases. Patients at risk for analgesic nonadherence can be identified during the preoperative period based on preoperative pain intensity, preoperative expectations of pain, and fear of surgery.

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.