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 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.