A Systematic Review and Meta-Analysis of the Association Between Pain-Related Fear and Pain Intensity in Experimental Pain Models

Objective: Pain is a multifaceted experience influenced by sensory and affective factors, with significant variability in perception among individuals that affects pain management and recovery. Pain-related fear (PRF) has been linked to a number of adverse outcomes in clinical pain populations, including pain intensity. Experimental studies offer unique insight into the direction and magnitude of the PRF-pain intensity relationship; however, results of relevant studies are mixed. The present meta-analysis aimed to synthesize findings of laboratory studies investigating PRF and pain intensity in order to estimate the pooled effect of this relationship as well as to evaluate potential moderators and competing variables contributing to between-study variability (preregistration ID: CRD42023432110). Methods: Searches in PubMed, PsychINFO, and Cochrane Library yielded 27 independent samples, totaling 1633 participants, that reported correlations between PRF and pain intensity in healthy, pain-free individuals. Results: Results revealed a pooled effect size that was positive and significant (r = 0.22, p < .001), with the magnitude of the relationship varying by PRF measurement tool (Q = 8.48, p = .004). Specifically, studies that used the Fear of Pain Questionnaire (McNeil and Rainwater, 1998) reported more robust effect sizes than alternative PRF measurement tools. Although competing psychological variables were related to both PRF and pain intensity, PRF predicted pain intensity over and above these factors. Conclusion: The present results indicate a unique positive effect of PRF, as measured in the absence of an ongoing pain experience, on later perceptions of pain intensity. The implications for future experimental pain studies and clinical translation are discussed.