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Uncertainty in a context of pain: disliked but also more painful?

Pain is part of a motivational system that urges the individual to take action when the integrity of the body is challenged. Although regularly updated information available from the internal and external environment is used to estimate the risk for such bodily threat, this process is fraught with uncertainties. Indeed, patients may dwell on the cause of their pain, its meaning, their future, when the next pain episode will occur, the intensity of their pain, or how to control it. Uncertainty denotes “a lack of sureness about someoneor something and may range from a falling short of certainty to an almost complete lack of conviction or knowledge, especially about an outcome or result” (Merriam-Webster.comDictionary, s.v. “uncertainty,” accessed July 15, 2020, https://www.merriam-webster.com/dictionary/uncertainty). Many different situations may give rise to uncertainty, of which unpredictability and uncontrollability are the most pertinent. When living with pain, uncertainty can emerge at different levels and through different origins that can affect the experience and impact of chronic pain. For instance, patientswith painmight experience high levels of uncertainty because of the ambiguity of their pain (eg, is it a sign of a life-threatening condition or not?), because of an inability to explain its origin (ie, lack of knowledge), or because of conflicting treatment information (ie, inconsistency, rest vs keep on moving). In clinical studies, uncertainty has been related to various negative behavioral outcomes. It is often suggested that uncertainty also aggravates pain perception, yet endeavors to investigate the relationship betweenuncertainty andpain perception in experimental settings have yielded mixed findings. This article aims to summarize research on this matter in an attempt to identify potential methodological and conceptual challenges to inspire future research.