This narrative review summarizes and integrates the available literature on PA and pain to: (1) Provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and chronic pain; (2) Provide a theoretical foundation from which to understand how PA operates in the context of chronic pain; and (3) Highlight how the prevailing psychosocial treatments for chronic pain address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with chronic pain. To that end, we review experimental studies that have assessed the association of evoked PA and pain sensitivity, as well as clinical studies that have assessed the association of naturally occurring PA and clinical pain in the context of chronic pain. The evidence suggests PA influences pain, over and above the influence of NA. We offer an "upward spiral" model of positive affect, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance chronic pain self-management.
(C) 2014 by Lippincott Williams & Wilkins