Interpretation bias and its relationship with pain: a systematic review and meta-analysis

Abstract The aim of this review was to systematically review and meta-analyse evidence for the presence of interpretation bias in pain and to establish the likely role of interpretation bias in chronic pain. The primary questions were whether people experiencing pain showed a greater interpretation bias than people without pain and whether interpretation bias was associated with pain outcomes. We were also interested in evaluating existing longitudinal and intervention research, which could inform interpretation bias as a causal mechanism and/or treatment target in pain. A total of 33 studies across 31 articles were identified (combined n = 4842). People with chronic pain showed a greater interpretation bias than people without pain, with a moderate effect ( g = 0.602). This effect was even more pronounced when interpretation bias was measured with the word association task, reaching a large effect size ( g = 0.899). Interpretation bias was associated with degree of pain interference, pain catastrophising, and less reliably with pain severity, but not with experimental pain outcomes. Longitudinal studies ( k = 3) were mixed as to whether interpretation bias predicted subsequent pain. Whereas, intervention studies ( k = 3) showed that interpretation bias could be modified and, for chronic pain, led to improved pain outcomes. Overall, data show that interpretation biases are robust among those with chronic pain compared with those without and are associated with pain interference. There is emerging evidence that interpretation biases are a treatment target that can be modified for improved pain outcomes.