Review articleInvestigating the influence of social support on experimental pain and related physiological arousal: A systematic review and meta-analysis
Introduction
Under the right conditions, having supportive relationships with others provides benefits to the individual (Cohen and Wills, 1985; Uchino, 2006). These benefits may arise through the forms of receiving supportive resources from others (e.g. emotional, economical, informational) and the perception that supportive resources are available should they be needed (Dunkel-Schetter and Bennett, 1990; Uchino, 2009). In the context of pain research, social support may be associated with the reduction of pain (Brown et al., 2003; Eisenberger et al., 2011) and related physiological arousal (Roberts et al., 2015; Sambo et al., 2010). For instance, holding the hand of a significant other or providing social support without actual presence (i.e. primed support) can reduce the intensity and/or unpleasantness of pain and heart rate increase evoked by painful stimuli (Che et al., 2017; Master et al., 2009).
In contrast, social support also has the potential to increase pain experience (Hurter et al., 2014; McClelland and McCubbin, 2008). Indeed, pain behaviours are in some instances suggested to be used to trigger sympathy or attention (Williams, 2002), and/or to avoid social responsibilities (Glenton, 2003). A recent review highlighted the contribution of potential covariates in the social modulation of pain. Specifically, social support in general decreases pain when it is clearly communicated (e.g. verbal support, ‘social support variations’), or in cases where it is provided by a significant other (e.g. romantic partner, ‘social relationships’) (Krahé et al., 2013). However, no study has characterised the magnitude of the influence of social support nor the modulating impact of potential covariates. Moreover, since the last systematic review (Krahé et al., 2013) there have been a number of additional studies published in this area (Edwards et al., 2017; Gallant and Hadjistavropoulos, 2017; Goldstein et al., 2016; Karmann et al., 2014; Roberts et al., 2015), with some of these studies also examining pain-related arousal which has not previously been assessed in a systematic review.
A growing body of research indicates the effectiveness of support-assisted therapies for the management of chronic pain (e.g., spouse-assisted coping skills training) (Keefe et al., 1996, 1999). However, in order to optimise these approaches, a better understanding of the context(s) in which social support has an analgesic effect is necessary. To this end, a meta-analysis was conducted to quantify the influence of social support on pain. Studies were limited to those that provided a no-support baseline condition relative to stranger or close other support. This helps to control the variability induced by baseline conditions (e.g. a stranger condition) and clarify the role of pre-existing social connections. Moreover, we quantified physiological changes evoked by painful stimuli in the context of social support. Physiological arousal is closely associated with health outcomes (Cohen and Wills, 1985; Uchino, 2006), and it may suggest ways in which social support modulates pain experience (Goldstein et al., 2017). This meta-analysis may help to summarise and quantify the complex and multivariate influence of social support on experimental pain and is intended to help direct future research and assist in the optimisation of treatment strategies.
Section snippets
Protocol and registration
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Moher et al., 2009). The protocol was registered in the database of International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42017076667).
Search strategy
A comprehensive electronic literature search was performed in PubMed, PsycINFO, The Cochrane Library and EMBASE to the end of August 2017. The keywords used for the search were ‘pain’ AND
Selection of studies and characteristics
Online database searches identified a total of 2416 records (Fig. 1). After duplicates were removed, 1836 studies remained. Initial screening of the title and abstract was performed against the inclusion and exclusion criteria. After excluding 1788 records from the initial screening, full-text versions of 48 studies were screened for eligibility. A total of 21 studies were included in the systematic review and meta-analysis, among which 21 were appropriate for behavioural outcome analysis and 6
Discussion
The present study aimed to quantify the influence of social support on pain and related physiological arousal. Built on the literature to date, we further examined two covariates, i.e. social support variations and social relationships, which have been largely reported to modulate social support effect on pain. Our data demonstrated that social presence alone did not affect pain perception. However, the presence of a significant other resulted in an increase of facial expression of pain, and
Conclusions and implications
Social support has been documented to modulate pain and related arousal for several decades. In this study, we systematically quantified these effects and possible covariates. The mere presence of another person, although it may impact physiological arousal, was not found to be sufficient to reduce pain. However, we did identify social support to decrease pain when it is more clearly expressed, e.g. verbal communication, hand-holding. Our findings also highlight the significance of intimate
Financial disclosures
None declared.
Conflicts of interest
There are no other conflicts.
Acknowledgments
XC is supported by the China Scholarship Council (201506990016). PBF is supported by a NHMRC Practitioner Fellowship (606907). BMF is supported by a NHMRC Early Career Fellowship.
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