Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises

Abstract

Purpose

Positive emotions have been found to be analgesic and can be induced by positive psychology exercises. This study tested if positive psychology exercises provide beneficial effects on pain, responses to pain, physical (pain interference), and emotional function.

Methods

Randomized parallel-group controlled single-blinded superiority-trial including community-dwelling individuals with chronic pain secondary to spinal cord injury. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises for 8 weeks. Participants in the control group were asked to be mindful and write about current life events.

Results

108 (64%) completed the study. At post-treatment, the intervention participants reported significant reductions in pain intensity and improvements in pain catastrophizing and pain control, relative to baseline. Both groups reported significant decreases in pain interference and negative emotions. Significant between-group differences emerged for pain intensity at post-treatment. At 3-months follow-up, improvements maintained for the intervention group and improvements in positive emotions reached statistical significance. Between-group differences were identified for pain intensity at post-treatment.

Conclusion

Positive psychology exercises represent a potential effective complementary treatment that result in benefits on pain which can be readily implemented into daily living. Trials designed with an inactive control condition should be conducted to further address efficacy.

Trial registration

Swiss ethics committee (EKNZ 2014-317)/clinicaltrials.gov (NCT02459028)

Registration date: Ethics approval 25.10.2014/Study start date: May 2015

URL of the record: https://clinicaltrials.gov/ct2/show/NCT02459028?term=NCT02459028&cntry=CH&draw=2&rank=1

IMPLICATIONS FOR REHABILITATION

• Pain engenders negative emotions (e.g., fear, anger, sadness) which can negatively affect psychological, social, and physical function.

• Positive emotions have been found to be analgesic and can be induced by practicing positive psychology exercises.

• The findings of the current randomized controlled trial provide support for practicing positive psychology exercises (beyond the effects of pain medication intake), in particular on the reduction of pain intensity, but also in improving pain catastrophizing and pain control.

• The majority of the positive psychology exercises are brief and self-administered positive activities that have no known negative side effects nor financial cost, can be tailored to a person's preferences in activities and can be readily implemented into daily living with chronic pain, complementing standard treatment of pain.

Keywords:

• Emotions
• chronic pain
• pain catastrophizing
• positive psychology
• randomized controlled trial
• spinal cord injury

Acknowledgments

The authors would also like to thank Valentine Habermacher for the support concerning classification of pain medication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch), supported by the Swiss Paraplegic Foundation. The members of the SwiSCI Steering Committee are: Xavier Jordan, Bertrand Léger (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Hans Georg Koch, (Swiss Paraplegic Association, Nottwil); Hardy Landolt (Representative of persons with SCI, Glarus); Hannjörg Koch (SUVA, Luzern); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Martin Brinkhof, Christine Thyrian (SwiSCI Study Center at Swiss Paraplegic Research, Nottwil).