Department of Human Development, Cornell University, Ithaca, NY.
Department of Medicine, Weill Cornell Medical College, New York City, NY, United States.
Pain. 2020 Jun;161(6):1140-1149. doi: 10.1097/j.pain.0000000000001828.
Chronic noncancer pain (CNCP) is a significant health burden among adults. Standard behavioral therapies typically focus on targeting negative affect (NA) and yield only modest treatment effects. The aims of this study were to systematically review and investigate the association between positive affect (PA) and pain severity among adults with CNCP. Databases that were searched included MEDLINE (PubMed), PsycINFO, CINAHL, ProQuest Dissertations and Theses, OLASTER, Open Grey, and PsyArXiv (inception to July 23, 2019). We analyzed studies that: (1) used observational, experimental, or intervention study designs; (2) enrolled individuals with CNCP (pain ≥ 12 weeks); and (3) reported full quantitative results on outcomes. Two researchers independently screened articles, extracted data, and assessed the risk of bias. The main meta-analysis was followed by subgroup analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (Q-statistic; I) and publication bias (p-curve and p-uniform*) were performed. We meta-analyzed 29 studies with 3521 participants. Results demonstrated that PA inversely impacts pain severity in people with CNCP (r = -0.23). Subgroup analyses showed a significant effect for gender and marginally significant effects for age in studies that adjusted for NA. On average, effect sizes for observational studies were larger in studies with a higher proportion of female respondents and in studies that did not adjust for NA. Finally, larger effect sizes were found in intervention studies with older compared with younger samples.
慢性非癌性疼痛（CNCP）是成年人健康的重大负担。标准的行为疗法通常侧重于针对负性情绪（NA），但仅产生适度的治疗效果。本研究旨在系统地回顾和研究成年人 CNCP 中积极情绪（PA）与疼痛严重程度之间的关系。搜索的数据库包括 MEDLINE（PubMed）、PsycINFO、CINAHL、ProQuest 学位论文和论文、OLASTER、Open Grey 和 PsyArXiv（成立至 2019 年 7 月 23 日）。我们分析了以下研究：（1）使用观察性、实验性或干预性研究设计；（2）纳入慢性非癌性疼痛患者（疼痛≥12 周）；（3）报告结局的全定量结果。两位研究人员独立筛选文章、提取数据并评估偏倚风险。主要的荟萃分析之后是亚组分析。所有分析均采用随机效应模型进行。进行了异质性的正式检验（Q 统计量；I）和发表偏倚检验（p 曲线和 p 均匀*）。我们荟萃分析了 29 项研究，涉及 3521 名参与者。结果表明，PA 与 CNCP 患者的疼痛严重程度呈负相关（r = -0.23）。亚组分析显示，在调整了 NA 的研究中，性别存在显著影响，年龄存在边缘显著影响。平均而言，在女性受访者比例较高的观察性研究中，以及在未调整 NA 的研究中，观察性研究的效应量较大。最后，在样本较年轻的干预研究中，发现了更大的效应量。
