Mindfulness physical therapy, pain management, rehabilitation

Can Positive Affect Attenuate Persistent Pain?

Substantial attention has been given to the impact of negative emotional states on persistent pain conditions. The adverse effects of anger, fear, anxiety and depression on pain are well-documented. Complementing this emphasis on negative emotions, Hanssen and colleagues suggest that interventions aimed at cultivating positive emotional states may have a role to play in pain reduction and/or improved well-being in patients, despite pain.1 They suggest positive affect may promote adaptive function and buffer the adversities of a chronic pain condition.

In a feasibility trial, 96 patients were randomized to a computer-based positive psychology intervention or control condition.2 The intervention required participants perform at least one positive exercise for at least 15 minutes at least 1 day/week for 8 weeks. The positive exercises included such tasks as performing good deeds for others, counting blessings, taking delight in life’s momentary wonders and pleasures, writing about best possible future selves, exercising or devoting time to pursuing a meaningful goal. The control group was instructed to be attentive to their surroundings and write about events or activities for at least 15 minutes at least 1 day/week for 8 weeks. Those in the positive psychology intervention demonstrated significant improvements in life satisfaction, depression, pain intensity, pain interference, and pain control at program completion and 2-month follow-up. Based on these promising results, authors suggest that a full trial of the intervention is warranted.

Hanssen and colleagues suggest positive psychology interventions could contribute to improved pain, mood and behavioral measures through various mechanisms.1 These include the modulation of spinal and supraspinal nociceptive pathways, buffering the stress reaction and reducing stress-induced hyperalgesia, broadening attention, decreasing negative pain-related cognitions, diminishing rigid behavioral responses and promoting behavioral flexibility.

Rehabilitation professionals commonly encourage patients with persistent pain conditions to participate in activities they enjoy. This can be expanded to include additional activities identified in the Muller article. (Please see the article for the complete intervention description.) In addition, mindful awareness can be included so that patients pay close attention to the physical sensations, emotions and thoughts that accompany positive experiences.

1Hanssen MM, Peters ML, Boselie JJ, Meulders A. Can positive affect attenuate (persistent) pain? Curr Rheumatol Rep. 2017;19(12):80.
2Muller R, Gertz KJ, Molton IR, et al. Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and physical disability: a feasibility trial. Clin J Pain.2016;32(1):32-44.