Saturday, January 5, 2013

Sunny Outlook Brightens Dark Clouds of Pain

OptimismPersons with optimistic dispositions often experience better mental and physical health, and also may be less worried about or sensitive to pain. However, a causal link between optimism and less pain has been unproven. New research helps to confirm that persons with positive, optimistic outlooks may be generally more tolerant of pain.

Researchers from the Department of Clinical Psychological Science, Maastricht University, The Netherlands, constructed an experiment to test the cause-effect relationship of dispositional optimism and pain sensitivity by inducing a temporary optimistic state in participants and then exposing them to a pain-inducing stimulus [Hanssen et al. 2013]. Would optimism reduce their self-reported perceptions of pain?

Writing in the January 2013 edition of the journal PAIN, the researchers report recruiting 79 university students for the laboratory experiment: mean age was 23 years, 81% women. They were randomly assigned to either an optimism group (n=40) or control group (n=39).

  • For the optimism condition, subjects were asked to think about their “best possible self” for several minutes and then to write about this topic for 15 minutes. They were then asked to visually imagine the story they wrote as vividly as possible for 5 minutes.

  • In the control condition, subjects went through the same process, but were asked to think about, write about, and visualize “a typical day.”

These exercises had been used in past research to effectively induce an optimistic versus a more neutral state of mind. Immediately following this, each subject immersed their nondominant hand up to the wrist in a tank of cold water (4° C, or 41° F) for up to 60 seconds, which served as a painful stimulus (cold pressor test). Pain was self-assessed by participants at several time points on 0-100 mm visual analog scales (VAS), and each subject also self-rated via questionnaire their level of dispositional optimism and mood, as well as pain expectation and catastrophizing.

The results indicated that participants in the induced-optimism group reported significantly lower pain-intensity ratings during the cold/pain stimulus than those in the control group. Thereby, this experimentally confirmed that a state of optimism engendered less perceived pain. And, this effect was not explained by how much pain participants expected to experience prior to the cold-water challenge; in other words, the dominant effect of optimism was not confounded by how painful participants thought the experience would be ahead of time.

Situational pain catastrophizing, however, did seem to mediate the relationship between optimism and pain. In this regard, subjects in the optimism group tended to think less negatively about pain in general — ie, less situational catastrophizing — and may have shifted their focus to more positive outlooks that facilitated less sensitivity to or tolerance of the pain stimulus.

The researchers conclude that their results suggest that clinical interventions facilitating more optimistic outlooks might reduce pain catastrophizing and produce more favorable pain management outcomes. Furthermore, the thinking, writing, and visualizing exercises focusing on “best possible self” may be a viable approach for inducing optimistic states in the context of pain.

COMMENTARY: This rather elaborately conducted and analyzed study appears to have a simple message: patients who can learn to focus more on the positive than the negative may be better able to cope with pain and have more successful treatment outcomes. Yet, the phenomenon and benefits of an optimistic outlook, from a science-based perspective, seems complex.

In background information provided in the article, the researchers note that dispositional optimism has been defined as the expectation of generally positive outcomes in any situation, which may translate to more positive (or less negative) expectations and perceptions of pain. Along with that, optimists are less inclined to process negative information and tend to shift their focus to more positive thoughts or features of a situation — eg, worry less — resulting in less catastrophizing. The current research study seems to confirm these observations.

However, there were considerable limitations of this research experiment. Although the study was of reasonable size to produce statistically valid results (total n=79), all of the subjects were young healthy university students, mostly females, and from a European culture. Whether the outcomes might translate to older persons in different communities, apart from a laboratory setting and including patients with pre-existing pain, is uncertain.

Furthermore, only short-term effects resulting from experimentally-induced pain that was largely nonthreatening in nature were assessed. The persistence of optimism and its pain-ameliorating effects over time is undetermined, and there is still the question of how this might apply to persons with chronic pain conditions. According to the research results an optimistic disposition might favorably enhance adaptive or coping mechanisms for dealing with pain, but inducing such an outlook in patients with long-term moderate to severe pain conditions might be clinically challenging.

REFERENCE: Hanssen MM, Peters ML, Vlaeyen JWS, et al. Optimism lowers pain: Evidence of the causal status and underlying mechanisms. PAIN. 2013(Jan);154(1):53-58 [abstract here].

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