Illness and treatment beliefs and health outcomes in chronic pain: a meta-analysis

Guided by the common-sense model of illness self-regulation, we examined zero-order and unique associations between illness and treatment beliefs and functioning and illness outcomes in a synthesis of research on chronic pain patients, and tested moderator and covariate effects on these associations. Studies reporting associations between illness and treatment beliefs and outcomes in chronic pain patients (k = 93, N = 18,262) were identified in a systematic database search. Data were analyzed using multi-level meta-analysis and meta-analytic structural equation modeling (MASEM). We found averaged zero-order intercorrelations among the illness and treatment beliefs and chronic pain outcomes (physical and psychological impairment, disease status, social/role functioning). Moderator analyses indicated that relations between perceived consequences and social/role functioning were larger, and between emotional representations and illness status smaller, in patients diagnosed with a pain condition relative to those without a diagnosis. MASEM indicated unique effects of perceived control and consequences beliefs on physical impairment, causal beliefs on psychological impairment, identity beliefs on disease status, and treatment beliefs on social/role functioning. Findings identify belief-based correlates of pain-related outcomes and provide formative evidence to guide pain management intervention strategies. Future longitudinal and experimental studies should permit causal inferences in model effects and test coping strategies as a candidate mechanism.