Fear of pain and pain intensity: Meta-analysis and systematic review.

The fear avoidance model (FAM) represents a cognitive-behavioral explanatory approach for pain chronification. The core assumption is that fear of pain (FOP) following an acute pain experience facilitates the development of pain chronification, disability, and receding functionality. Thus, the model predicts a positive association between FOP and pain intensity in pain patients, which was frequently investigated; however, results were inconsistent. To highlight inconsistencies, we performed integrative statistical analysis aimed at evaluating the strength of the cross-sectional relation between FOP and pain intensity in clinical research and reviewing its moderation through demographic, pain-specific and psychosocial characteristics. To this end, we searched the databases PsycINFO, PubMed, and Web of Science and included 253 independent effect size estimates (N = 42 463). The overall mean effect size was computed based on a random-effects model. By utilizing the artifact distribution method, we supplemented it with an analysis correcting for artifacts. The magnitude of the positive association equated to the threshold between a small to medium effect size, which was expected as the FAM predicts an indirect relation only. The association turned out to be stable across different FOP measures, but was significantly moderated by age, pain localization, first-time pain episode, pain onset, treatment status, and anxiety sensitivity. A potentially necessary differentiation of patient subgroups and suggestions for an adjusted methodological approach of future research are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).