Does being optimistic, pessimistic or realistic make any difference in pain outcomes for those with neuropathic pain?

Almost 800 patients with neuropathic pain were retrospectively studied to determine the association between unrealistic and realistic expectations with outcomes after multidisciplinary treatment.

Four categories of expectations were studied.

Unrealistic expectations were those whose expected reduction in pain was greater than the observed mean group reduction in pain (i.e. they assumed that they would rapidly improve in a matter of days or weeks)

Realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain (i.e. they appreciated that improvements would be slow and that it would take a few months to get better)

Pessimistic expectations were those who under-estimated the expected response to treatment (i.e. they did not believe that treatments would help them)

Optimistic expectations were those who over-estimated the expected response to treatment (i.e. they believed that treatments would be very helpful)

Result #1: Patients with realistic expectations had lower levels of disability, catastrophizing and psychological distress

Result #2: Patients with optimistic expectations had lower levels of disability

Result #3: Patients with pessimistic expectations had higher levels of catastrophizing and psychological distress

Simple conclusion: If you are currently dealing with neuropathic pain, it may be wise to be both realistic and optimistic about your treatments. In other words, expect that treatments will eventually help you; but that it will takes months… so be patient.

Those who are unrealistic and pessimistic will have a hard time with their recovery as they expect to rapidly improve; yet don’t expect the treatments to be of benefit.

I always like to look on the optimistic side of life, but I am realistic enough to know that life is a complex matter. – Walt Disney

Although attitudes and expectations may influence disability and psychological distress, they do not seem to influence the actual recovery time for neuropathic pain. Neuropathic pain is certainly a horrible condition and I do not wish to minimize it by telling people to just be optimistic.

Studies to date do not support that being optimistic makes any difference in outcomes for patients with cancer.2 Being realistic and optimistic may not have any impact on recovery or the length of life but seem to help improve the quality of life and reduce psychological distress in those with various illnesses, from neuropathic pain to terminal cancer.2

 Pain is inevitable, suffering is optional – Buddha’s teaching

The big question is, can pessimistic people change and become optimistic? I’m not sure, as it’s mostly in our DNA/genetics!


References: Bostick GP Pain expectations in neuropathic pain: Is it best to be optimistic? Eur J Pain. 2017 Apr;21(4):605-613.

  1. Schofield P et al Optimism and survival in lung carcinoma patients. Cancer. 2004 Mar 15;100(6):1276-82.
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