Research suggests that pain negatively affects body image, and body image may also influence reported pain levels. This review aims to summarize the literature on differences in body image distortion between individuals with pain compared to pain-free individuals. The review was conducted according to the PRISMA 2020 statement and an a priori pre-registered protocol. The literature was searched using five electronic databases. Studies assessing body image with the Fremantle Awareness Questionnaire (FAQ) in individuals with and without pain were eligible for inclusion. Screening and selection of eligible studies was performed by independent reviewers. Methodological quality was assessed with the Joanna Briggs Institute (JBI) critical appraisal tool. Meta-analyses, meta-correlations and metamean analyses were performed using random-effect models. The primary outcome was the FAQ score; secondary outcomes were reported pain variables. Data from individuals with pain (n=2277) and without pain (n=615) were summarized. Significant body image distortions were found in individuals with pain compared to individuals without pain. Compared to pain-free individuals, the pain group rated significantly higher in the FAQ when experiencing back pain (SMD = 1.33, 95% CI = 0.88 to 1.77]) or other body parts (SMD = 1.25, 95% CI = 0.51 to 1.99). The results of meta-correlation analyses confirmed the positive relationship between body image distortion and pain intensity (r=0.31), pain at rest (r=0.31), or pain during movement (r=0.36), but not for pain duration. A difference in mean FAQ results was observed between individuals with pain in different areas (knee and back). Registered protocol at Prospero: CRD42022309937 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309937 PERSPECTIVE: This review confirms differences in body image distortion between individuals with pain and pain-free individuals. Pain intensity was correlated with altered body perception, but not pain duration. A moderate correlation was observed between body image distortion and reported pain variables. Greater body image impairment was observed when pain was reported in the knee compared to the back.

Introduction . The aim of the study was twofold. The first aim was to specify attitudes toward using performance-enhancing drugs (doping) among athletes practising different sports disciplines. The second aim was to present the Polish version and validation of the Performance Enhancement Attitude Scale (PEAS). Material and methods . A total of 340 athletes (173 males and 167 females) took part in the study. They represented 13 sport disciplines. The study was conducted in Central Sports Centres in Poland. Athletes’ attitudes were assessed using the Performance Enhancement Attitude Scale (PEAS). Results . The study revealed that athletes generally were not tolerant in relation to illegal performance-enhancing substances in sport. However, men were more permissive toward illegal performance enhancement than women. The other important factor, apart from gender, was the amount of contact between competitors. The lowest values were found for sports where athletes competed parallel to each other, medium values were recorded for sports where athletes were in close contact, and the highest values were found in the group of athletes having no contact with the competitors. Our analyses also confirmed that the 11-item version of PEAS has the best fit indices and therefore is most recommended for use among Polish athletes. Conclusions . The Polish version of PEAS is recommended in its 11-item version, and its reliability was confirmed. According to the findings of the study, Polish athletes rather do not approve of doping behaviours. Men were more likely to use illegal substances than women. The most positive attitude towards doping was found for sport disciplines where there is no contact with the competitor.

Background: This study aimed to analyze factors differentiating body appreciation among Polish elite athletes. Material and Methods: Participants were athletes, both men and women (N=408), who completed questionnaire BAS-2. Results: In general, men had a better perception of their body than women (p<0.01). Higher appreciation of the body was visible among women sprinters, opposite to volleyball players (p <0.03). Indirect competition for women was connected to higher body appreciation (p<0.05). Gender and individual/team sport also significantly differentiated appreciation of the body (p<0.02). Furthermore, training frequency in a week differentiated body appreciation (p<0.03), as well as characteristic of sports performance [indoor sports, and higher in water sports (p<0.02)]. Conclusions: Results suggest that not only the common category of the sport type – aesthetic, technical, strength – differentiates the body image. Equally important for differences in body appreciation is also gender, sport discipline, and background of sport training: frequency per week, the character of competition (direct-indirect), individual/non-individual competition, or characteristic of sports performance.

Observational learning (OBL) can elicit placebo hypoalgesia or nocebo hyperalgesia if pain relief or exacerbation is observed after placebo administration. While dispositional empathy has occasionally been associated with increased placebo and nocebo responding, the contribution of situational empathy remains elusive. This study addresses this gap using a validated experimental paradigm. Healthy individuals (n=180, 60% females) were randomized to four experimental (placebo-OBL, high-empathy placebo-OBL, nocebo-OBL, high-empathy nocebo-OBL) or two control groups (random-ratings OBL, no-observation). Medium pain was evoked at baseline and post-OBL with heat stimuli to both arms. Before OBL, a placebo ointment was applied to one arm. In the experimental groups, participants observed a model expressing hypoalgesia or hyperalgesia in reaction to the ointment. In the empathy groups, participants were instructed to empathize with the model. OBL did not alter pain intensity (F(3,176)=1.02, p=.39, η_p²=.02), although pain expectations changed in the expected direction (F(5.76,337.84)=5.81, p<.001, η_p²=.09). There were no between-group differences in situational empathy (indicating a failed empathy manipulation), and the magnitude of placebo hypoalgesia, or nocebo hyperalgesia (all p's≥.19). The current study is one of only a few highlighting the limits of OBL-induced placebo and nocebo effects. It suggests that changing expectations alone may not always be sufficient to produce changes in pain perception. Potential factors explaining these findings, including attention and cognitive load, are discussed. Increasing our understanding of OBL-induced pain changes can support the development of interventions for (chronic) pain. Studying the contribution of empathic processes may be particularly relevant given their vital role in human interactions. PERSPECTIVE: This article presents the results of an experimental mixed-model study on state empathy and placebo hypoalgesia and nocebo hyperalgesia, induced by observational learning (OBL). Although expectations changed, empathy and OBL did not elicit any changes in the experience of pain. The findings highlight the limits of OBL for altering pain.

Body image disturbance is observed in individuals with chronic low back pain (CLBP) and is a potential treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is designed to identify disrupted body image specific to the low back. This study aimed to develop and assess the measurement properties of a Polish language version of this questionnaire (FreBAQ-PL). Following the translation process, cognitive interviews were carried out as a qualitative assessment of content validity. Subsequently a quantitative assessment of content validity was undertaken among in a study sample with CLBP and experts. Measurement properties were assessed in 114 participants with CLBP and 53 pain-free participants. The CLBP sample repeated the FreBAQ-PL assessment within 14-days. The measurement properties assessed in this study were content validity, internal consistency, frequency of responses, known-groups validity, convergent validity and test-retest reliability. Content validity was supported, affirming relevance and comprehensiveness. Known-groups validity was confirmed by significant differences in FreBAQ-PL scores between participants with CLBP and pain-free participants (p < 0.05). Convergent validity was established through moderate associations between FreBAQ-PL scores and pain variables (intensity and duration) (ρ's = 0.24-0.27, p's < 0.01), disability (ρ = 0.34, p < 0.01), kinesiophobia (ρ = 0.37, p < 0.01), depression (ρ = 0.30, p < 0.01) and anxiety (ρ = 0.24, p < 0.01). The scale was internally consistent (Cronbach's alpha 0.81). Test-retest reliability was good (ICC 0.90). The FreBAQ-PL is a reliable, internally consistent, and valid measure that can be used in clinical and research settings to assess the presence of body image disturbance in Polish-speaking individuals with CLBP.