title: Pain expectations in neuropathic pain: Is it best to be optimistic?
abstract: Pain expectancy may be an important variable that has been found to influence the effectiveness of treatments for pain. Much of the literature supports a self-fulfilment perspective where expectations for pain relief predict the actual pain experienced. However, in conditions such as neuropathic pain (NeP) where pain relief is difficult to attain, expectations for pain relief could be unrealistic. The objective of this study was to investigate the relationship between realistic/unrealistic expectations and 6-month, post-treatment outcomes.
  
  
  
  We performed a retrospective analysis of a large cohort of patients with NeP (n = 789) attending tertiary care centres to determine the association between unrealistic (both positive and negative) and realistic expectations with outcomes after multidisciplinary treatment. An expectation variable with three categories was calculated: realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain, while optimistic and pessimistic expectations were those who over- or under-estimated the expected response to treatment, respectively. The association between baseline realistic/unrealistic expectations and 6-month pain-related disability, catastrophizing and psychological distress was assessed.
  
  
  
  Univariable analyses suggested that realistic expectations were associated with lower levels of disability, catastrophizing and psychological distress, compared to unrealistic expectations. However, after adjustment for baseline symptom severity, multivariable analysis revealed that patients with optimistic expectations had lower levels of disability, than those with realistic expectations. Those with pessimistic expectations had higher levels of catastrophizing and psychological distress at follow-up.
  
  
  
  These findings are largely congruent with the self-fulfilment perspective to expectations.
  
  
  
  This study defined realistic pain expectations with patient data. Examining the relationship between expectations between pain and disability in a large cohort of patients with neuropathic pain.
authors.affiliation: Department of Physical Therapy, University of Alberta, Edmonton, Canada.
authors.forename: G P
authors.initials: GP
authors.lastname: Bostick
authors.affiliation: The George Institute for Global Health, University of Sydney, NSW, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Kamper
authors.affiliation: Department of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: Haanstra
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Psychiatry and Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: B D
authors.initials: BD
authors.lastname: Dick
authors.affiliation: LW Stitt Statistical Services, London, ON, Canada.
authors.forename: L W
authors.initials: LW
authors.lastname: Stitt
authors.affiliation: Department of Anaesthesiology, Pain Management and Peri-operative Medicine, Western University, London, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Morley-Forster
authors.affiliation: Department of Anaesthesia, Dalhousie University, Halifax, NS, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Clark
authors.affiliation: Department of Anaesthesia, Dalhousie University, Halifax, NS, Canada.|Departments of Psychiatry and Pharmacology, Dalhousie University, Halifax, NS, Canada.
authors.forename: M E
authors.initials: ME
authors.lastname: Lynch
authors.affiliation: Department of Medicine, Division of Neurology, University of Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Department of Anaesthesiology, University of Ottawa, ON, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Nathan
authors.affiliation: Department of Anaesthesiology, University of Ottawa, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Smyth
authors.affiliation: Departments of Family Medicine and Anaesthesia, McGill University, Montreal, QC, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Ware
authors.affiliation: Fraser Valley Health Authority, Surrey, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Toth
authors.affiliation: Departments of Neurological Sciences and Oncology, Western University, London, ON, Canada.
authors.forename: D E
authors.initials: DE
authors.lastname: Moulin
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000523:psychology*; D058443:Catastrophization / Q000523:psychology*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome