The Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis


Author: Annabel Horsburgh1, Simon J Summers2, Aidan Lewis3, Richard J Keegan4, Andrew Flood3

Affiliation: <sup>1</sup> University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia. Electronic address: annabel.horsburgh@gmail.com.

<sup>2</sup> Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.

<sup>3</sup> University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.

<sup>4</sup> University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, Australian Capital Territory, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.
Conference/Journal: J Pain
Date published: 2024 Jan 18
Other:
  Pages: S1526-5900(24)00349-3   ,  Special Notes: doi: 10.1016/j.jpain.2024.01.341.   ,  Word Count: 308  
    Interoception refers to the ability to sense internal bodily sensations. Research suggests that dysfunctions in interoception may be implicated in the transition to chronic pain, however little work has examined interoceptive ability in pain states. Therefore, this systematic review aimed to assess whether interoception is altered in individuals experiencing pain. Following a systematic search of four electronic databases from inception to February 2023, twenty-eight studies were included. Outcomes of interoceptive accuracy, interoceptive sensibility, and interoceptive awareness were meta-analysed. Risk of bias was assessed, and certainty of evidence was evaluated. Meta-analyses indicated that those with chronic pain display reduced interoceptive accuracy and increased interoceptive sensibility. Subgroup analyses indicated that the change in interoceptive sensibility is dependent on the measure used, with those with chronic pain scoring higher on measures focusing on attention to bodily sensations, while also scoring lower on emotional reactivity. No difference in interoceptive awareness was observed between individuals with chronic pain and pain-free controls. Only one study was found that measured interoception in those experiencing acute pain, while another study recruited those experiencing recurrent pain. These findings suggest that while those with chronic pain self-report as more interoceptively aware, they are less accurate at detecting internal bodily signals. Further research investigating domains of interoception in those experiencing acute and recurrent pain is needed. Data should be interpreted with caution as the certainty of evidence was very low for all completed analyses. This review was registered on the PROSPERO international prospective register of systematic reviews (Registration ID = CRD42022318843). PERSPECTIVE: This review considered the relationship between interoception and pain, and found that an individual's ability to accurately sense internal signals is decreased in those with chronic pain, despite them reporting being more aware of internal sensations. However, there remains little research examining interoception in non-chronic pain states.



Keywords: Interoception; chronic pain; meta-analysis; pain; systematic review.



PMID: 38244898 DOI: 10.1016/j.jpain.2024.01.341