Dynamic pain-emotion relations in chronic pain: a theoretical review of moderation studies

Current developments in chronic pain research are changing the focus in the study of pain-emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra- and interpersonal levels has significant clinical implications for psychological adjustment to chronic pain conditions, and thus represents an important topic for both clinical and health psychology. This article reviews the existing theoretical explanations of these dynamics and their emerging empirical support, and suggests further areas of investigation. A literature search identified research on moderators of pain-emotion relations in chronic pain; existing theories were also examined from this perspective. A theoretical analysis revealed several important contributions, including the concepts of affect differentiation, generalised discrimination ability, resilience, vulnerability, coping, emotion regulation and desynchrony, which are described here together with the relevant empirical research and clinical implications. Important areas for development are the clarification of the common elements and opposing predictions and the empirical examination of mediating mechanisms. Several methodological issues are discussed. This review identifies a rich theoretical basis for research into pain-emotion moderation, and suggests that further examinations of such relationships might hold important clinical consequences.