Psychological functioning of people living with chronic pain: A meta-analytic review
Objectives Chronic pain (CP; >3 months) is a common condition that is associated with significant psychological problems. Many people with CP do not fit into discrete diagnostic categories, limiting the applicability of research that is specific to a particular pain diagnosis. This meta‐analysis...
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Published in | British journal of clinical psychology Vol. 54; no. 3; pp. 345 - 360 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
England
Blackwell Publishing Ltd
01.09.2015
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Subjects | |
Online Access | Get full text |
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Summary: | Objectives
Chronic pain (CP; >3 months) is a common condition that is associated with significant psychological problems. Many people with CP do not fit into discrete diagnostic categories, limiting the applicability of research that is specific to a particular pain diagnosis. This meta‐analysis synthesized the large extant literature from a general CP, rather than diagnosis‐specific, perspective to systematically identify and compare the psychological problems most commonly associated with CP.
Methods
Four databases were searched from inception to December 2013 (PsychINFO, The Cochrane Library, Scopus, and PubMed) for studies comparing the psychological functioning of adults with CP to healthy controls. Data from 110 studies were meta‐analysed and Cohen's d effect sizes calculated.
Results
The CP group reported experiencing significant problems in a range of psychological domains (depression, anxiety, somatization, anger/hostility, self‐efficacy, self‐esteem and general emotional functioning), with the largest effects observed for pain anxiety/concern and somatization; followed by anxiety and self‐efficacy; and then depression, anger/hostility, self‐esteem and general emotional functioning.
Conclusions
This study demonstrates, for the first time, that individuals with CP are more likely to experience physically focussed psychological problems than other psychological problems and that, unlike self‐efficacy, fear of pain is intrinsically tied to the CP experience. This challenges the prevailing view that, for individuals with CP, problems with depression are either equal to, or greater than, problems with anxiety, thereby providing important information to guide therapeutic targets.
Practitioner points
Positive clinical implications
This is the first time that the CP literature has been synthesized from a general perspective to examine psychological functioning in the presence of CP and provide practical recommendations for assessment and therapy.
Individuals with CP were most likely to experience psychological problems in physically focussed areas – namely pain anxiety/concern and somatization.
Although fear of pain was intrinsically tied to the CP experience, self‐efficacy was not.
CP was more strongly associated with anxiety than with depression.
Limitations
The study focuses on the general CP literature, adults and research‐utilizing self‐report measures.
Meta‐analyses are limited by the empirical literature on which they are based. |
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Bibliography: | Janssen-Cilag Mundipharma istex:840204BC084A1E9C908AE778F3E514AD36DB0DE0 ArticleID:BJC12078 Royal Adelaide Hospital Research Foundation Allied Health Grant Pfizer Australia Medtronic Australasia Mundipharma and Pfizer/Elixir Health Figure S1. Cohen's d effect sizes for (a) depression; overall and by measure, (b) anxiety; overall and by measure, (c) pain anxiety/concern; overall and by measure, (d) somatisation, anger/hostility, self-efficacy and self-esteem; overall and by measure, (e) general emotional functioning; overall and by measure.Table S1. (a) Search strategies used by search engine; (b) Demographic information retrieved from studies; (c) Studies included in the analyses for depression, by measure; (d) Studies included in the analyses for anxiety, by measure; (e) Studies included in the analyses for pain anxiety/concern, by measure; (f) Studies included in the analyses for somatisation, anger/hostility, self-efficacy and self-esteem, by measure; and (g) Studies included in the analyses for general emotional functioning, by measure. ark:/67375/WNG-CRK4CZ7X-2 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-3 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 |
ISSN: | 0144-6657 2044-8260 |
DOI: | 10.1111/bjc.12078 |