Background & aims: In line with the “Behavioral Model of Healthcare Utilization” proposed by Andersen, HCU can be seen as a behavioral action, possibly influenced by cognitions and emotions. Several studies investigated relationships between cognitive and emotional factors (CEF) and HCU, but a comprehensive overview of current evidence in patients experiencing pain is lacking. Therefore, the aim of this systematic review is to provide an overview of the evidence for the research question “Are cognitive and emotional factors related to HCU in patients experiencing pain?”.
Methods: A systematic search was conducted in PubMed, Web of Science and EconLit (final search: April 27, 2018). Full-text articles investigating the relationship between cognitive and emotional factors, assessed with self-reported instruments, and HCU in adults experiencing pain were eligible for inclusion. Downs & Black checklist (modified) was used for critical appraisal. Screening and critical appraisal were performed by 2 reviewers independently. Data extraction was performed by the first reviewer and checked for correctness by the second. Discrepancies were discussed between both reviewers assisted by the last author. HCU and CEF outcomes were clustered for interpretation based on the input from experts in the field. Level of association accounting for risk of bias was determined for each realtionship between a particular type of HCU and CEF.
Results: Systematic search resulted in 3,181 unique studies, of which 78 were eligible for inclusion. Positive univariate associations were found between (1) depressive symptoms and opioid use, pain medication use and consultations, (2) anxiety symptoms and opioid use and pain medication use, (3) catastrophizing and pain medication use and (4) fear-avoidance beliefs and consultations. Multivariate analyses showed positive associations between (1) depressive symptoms and pain medication use, (2) anxiety symptoms and primary care visits and (3) catastrophizing and pain medication use and consultations. Other analyses showed either no association or inconsistent/uncertain findings for relationships between particular CEF and types of HCU.
Conclusion: Findings for associations between CEF and HCU are very diverse. However, this review provides the ideal fundament for the development of therapy options addressing these modifiable cognitive and emotional factors which showed a relationship with HCU to keep HCU to the optimal minimum. Implementing such interventions may lead to important decreases in the socio-economic burden related to pain.

THE RELATIONSHIP BETWEEN PAIN-RELATED COGNITIVE AND EMOTIONAL FACTORS AND HEALTHCARE UTILIZATION: A SYSTEMATIC REVIEW