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The Role of Positive Affect in Pain and Its Treatment

Finan, Patrick H. PhD*; Garland, Eric L. PhD

doi: 10.1097/AJP.0000000000000092
Review Articles

Objective: This narrative review summarizes and integrates the available literature on positive affect (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 pain; (2) provide a theoretical foundation from which to understand how PA operates in the context of chronic pain (CP); and (3) highlight how the prevailing psychosocial treatments for CP address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with CP.

Results: In experimental studies, the evidence suggests PA is analgesic. In clinical studies, the association of PA and pain is dynamic, time variant, and may be best considered in context of its interacting role with negative affect.

Discussion: We offer an “upward spiral” model of PA, 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 CP self-management.

*Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD

Hunstman Cancer Institute, University of Utah, Salt Lake City, UT

Supported by funding from NIH/NINR 1P30 NR014131 (P.H.F.), Baltimore, MD, and NIH R03DA032517 (E.L.G.) Salt Lake City, UT. The authors declare no conflict of interest.

Reprints: Patrick H. Finan, PhD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5501 Nathan Shock Dr., Suite 100, Baltimore, MD 21224 (e-mail:

Received November 26, 2013

Received in revised form April 7, 2014

Accepted February 24, 2014

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