Are Positive Psychology Interventions Efficacious in Chronic Pain Treatment? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective Although positive psychology interventions are increasingly popular in chronic pain treatment their efficacy is still unclear. The objective is to summarize evidence on the effect of positive psychology interventions (PPIs) on pain, physical functioning, and emotional functioning in adults with chronic pain. Methods Four electronic databases and additional references were searched for randomized controlled trials published between 1990 and 2020. Findings from included studies were qualitatively and quantitatively synthesized, and study quality was assessed for risk of bias. A random effects meta-analysis model was applied for outcomes with more than four findings. Results Of 16 included randomized controlled trials, almost half delivered positive psychology interventions as self-help online interventions, and half conducted guided face-to-face interventions which lasted mostly eight weeks. Results from meta-analysis showed beneficial effects of positive psychology interventions compared to the control group on pain intensity and emotional functioning (i.e., less depressive symptoms, pain catastrophizing, negative affect; more positive affect) post-intervention. At 3-month follow-up, beneficial effects were maintained for depressive symptoms and positive and negative affect, but not for pain catastrophizing. However, the evidence on the long-term efficacy of PPIs and the efficacy of PPIs on physical functioning remains limited. Conclusion This review supports the notion that positive psychology interventions are beneficial to chronic pain treatment, although further, high quality research is needed to support this conclusion.

Lessons in Affect Regulation to Keep Stress and Pain UndeR control (LARKSPUR): Design of a randomized controlled trial to increase positive affect in middle-aged and older adults with fibromyalgia

“…A meta-analysis of 29 observational and experimental studies documented a protective effect of PA on pain severity in adults with chronic non-cancer pain [26]. These findings are in line with a recent systematic review and meta-analysis of randomized controlled trials (RCTs) showing beneficial effects of positive psychology interventions (PPI) in chronic pain treatment [27]. Thus, evidence supports applying PPIs in the treatment of chronic 4 pain [27,28], yet the implementation of PPI approaches into clinical practice has been slow and varied [19,20].…”

“…These findings are in line with a recent systematic review and meta-analysis of randomized controlled trials (RCTs) showing beneficial effects of positive psychology interventions (PPI) in chronic pain treatment [27]. Thus, evidence supports applying PPIs in the treatment of chronic 4 pain [27,28], yet the implementation of PPI approaches into clinical practice has been slow and varied [19,20]. Potential barriers include high patient burden associated with privacy concerns, time, and mobility or travel limitations [18,29].…”

“…include pain intensity and pain interference measured by the PROMIS-SI and PROMIS-PI scales at baseline, post-intervention, and 1-month follow-up. The scales were selected to best match pain symptomatology conceptually predicted by previous research [27,121,122]. The PROMIS-SI includes 3 items that ask participants to rate pain intensity over "the past 7 days" and "right now" using a 0 = no pain to 4 = very severe rating scale [123].…”

Don’t get boxed in

“…Studies in people with chronic pain show that positive affect may be depleted during pain and stress, and that positive affect inversely predicts pain reports (Zautra, Fasman, et al, 2005;. Moreover, positive psychology interventions have been shown to successfully promote positive affect, wellbeing and functioning, and reduce pain severity and depression in individuals suffering from chronic pain [see Ong et al (2020) and Braunwalder et al (2022) for systematic reviews].…”

“…Because of its assumed contribution to chronic pain disability, investigating ways to mitigate avoidance overgeneralization may help optimize therapies. Increasing evidence shows that it may be beneficial to target positive affect in pain treatment (Finan & Garland, 2015;Hanssen et al, 2017); positive psychology interventions successfully augment positive affect, wellbeing and functioning, and reduce pain severity and depression in individuals with chronic pain (Braunwalder et al, 2022;Ong et al, 2020). Geschwind et al (2015) showed that experimentally induced positive affect is associated with less generalization of pain-related fear.…”