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Burke, Anne L. J.; Mathias, Jane L.; Denson, Linley A.

Psychological functioning of people living with chronic pain: A meta‐analytic review

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  • Media type: E-Article
  • Title: Psychological functioning of people living with chronic pain: A meta‐analytic review
  • Contributor: Burke, Anne L. J.; Mathias, Jane L.; Denson, Linley A.
  • imprint: Wiley, 2015
  • Published in: British Journal of Clinical Psychology
  • Language: English
  • DOI: 10.1111/bjc.12078
  • ISSN: 0144-6657; 2044-8260
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Objectives</jats:title><jats:p>Chronic pain (<jats:styled-content style="fixed-case">CP</jats:styled-content>; &gt;3 months) is a common condition that is associated with significant psychological problems. Many people with <jats:styled-content style="fixed-case">CP</jats:styled-content> 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 <jats:styled-content style="fixed-case">CP</jats:styled-content>, rather than diagnosis‐specific, perspective to systematically identify and compare the psychological problems most commonly associated with <jats:styled-content style="fixed-case">CP</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Four databases were searched from inception to <jats:styled-content style="fixed-case">D</jats:styled-content>ecember 2013 (PsychINFO, The Cochrane Library, <jats:styled-content style="fixed-case">S</jats:styled-content>copus, and <jats:styled-content style="fixed-case">P</jats:styled-content>ub<jats:styled-content style="fixed-case">M</jats:styled-content>ed) for studies comparing the psychological functioning of adults with <jats:styled-content style="fixed-case">CP</jats:styled-content> to healthy controls. Data from 110 studies were meta‐analysed and <jats:styled-content style="fixed-case">C</jats:styled-content>ohen's <jats:italic>d</jats:italic> effect sizes calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The <jats:styled-content style="fixed-case">CP</jats:styled-content> 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This study demonstrates, for the first time, that individuals with <jats:styled-content style="fixed-case">CP</jats:styled-content> 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 <jats:styled-content style="fixed-case">CP</jats:styled-content> experience. This challenges the prevailing view that, for individuals with <jats:styled-content style="fixed-case">CP</jats:styled-content>, problems with depression are either equal to, or greater than, problems with anxiety, thereby providing important information to guide therapeutic targets.</jats:p></jats:sec><jats:sec><jats:title>Practitioner points</jats:title><jats:p>Positive clinical implications</jats:p><jats:p> <jats:list list-type="bullet"> <jats:list-item><jats:p>This is the first time that the <jats:styled-content style="fixed-case">CP</jats:styled-content> literature has been synthesized from a general perspective to examine psychological functioning in the presence of <jats:styled-content style="fixed-case">CP</jats:styled-content> and provide practical recommendations for assessment and therapy.</jats:p></jats:list-item> <jats:list-item><jats:p>Individuals with <jats:styled-content style="fixed-case">CP</jats:styled-content> were most likely to experience psychological problems in physically focussed areas – namely pain anxiety/concern and somatization.</jats:p></jats:list-item> <jats:list-item><jats:p>Although fear of pain was intrinsically tied to the <jats:styled-content style="fixed-case">CP</jats:styled-content> experience, self‐efficacy was not.</jats:p></jats:list-item> <jats:list-item><jats:p><jats:styled-content style="fixed-case">CP</jats:styled-content> was more strongly associated with anxiety than with depression.</jats:p></jats:list-item> </jats:list> </jats:p><jats:p>Limitations</jats:p><jats:p> <jats:list list-type="bullet"> <jats:list-item><jats:p>The study focuses on the general <jats:styled-content style="fixed-case">CP</jats:styled-content> literature, adults and research‐utilizing self‐report measures.</jats:p></jats:list-item> <jats:list-item><jats:p>Meta‐analyses are limited by the empirical literature on which they are based.</jats:p></jats:list-item> </jats:list> </jats:p></jats:sec>