Positive affect as a factor of resilience in the pain—negative affect relationship in patients with rheumatoid arthritis
The purpose of this study is to examine positive affect (PA) as a factor of resilience in the relationships between pain and negative affect (NA) in a sample of patients with rheumatoid arthritis. Forty-three patients (30 women; mean age, 57 years) were interviewed weekly by telephone for 8 weeks. Multilevel modeling was applied to study the within-week relationships among the variables. There was a Pain x PA interaction effect on NA (beta=-0.05, P<.01) indicating a weaker relationship between pain and NA in weeks with more PA. Pain (beta=0.37, P<.002), interpersonal stress (beta=2.42, P<.001), depression (beta=0.26, P<.01), average perceived stress (beta=10.80, P<.001), and also weekly PA (beta=-0.1, P<.01) had a main effect upon NA. Positive affect is most influential in reducing NA during weeks of higher pain and may be a factor of resilience, helping patients experiencing pain fluctuations as less distressful than at lower levels of PA.
[Show abstract] [Hide abstract] ABSTRACT: Affective instability, conceptualized as fluctuations in mood over time, has been related to ill-health and psychopathology. In this study we examined the role of affective instability upon daily pain outcomes in 70 chronic pain patients (Mage = 49.7 years; 46 females) using an end-of-day diary. During a baseline phase, patients completed self-reported questionnaires of pain severity, pain duration, disability, depression and anxiety. During a subsequent diary phase, patients filled out an electronic end-of-day diary over 14 consecutive days assessing daily levels of pain severity, disability, cognitive complaints, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences (MSSD) in daily mood (separately for NA and PA), which takes into account the size of affective changes over consecutive days. Results indicated that NA instability was positively associated with daily disability, beyond the effects of daily pain severity. Furthermore, NA instability moderated the relationship between daily pain severity and daily disability and the relationship between daily pain severity and daily cognitive complaints. PA instability, however showed to be unrelated to all outcomes. Current findings extend previous results and reveal the putative role of affective instability upon pain-related outcomes and may yield important clinical implications. Indeed, they suggest that targeting NA instability by improving emotion regulation skills may be a strategy to diminish disability and cognitive complaints in patients with chronic pain.
- "Questionnaire research, however, does not capture well the temporal dynamics of affect. Indeed, chronic pain patients experience fluctuations not only in pain , but also in NA and PA [51,62,63]. Investigating moment-to-moment variations in affect may further our understanding of chronic pain and associated problems. "
[Show abstract] [Hide abstract] ABSTRACT: Factors contributing to resilience in chronic pain have garnered increased attention in recent years, and research has identified physical and psychosocial characteristics and mechanisms that enhance adaptation to pain, and a host of iatrogenic effects of medications that attempt to end the pain altogether. Ambiguity remains regarding what constitutes resilience to pain, and which factors that influence resilience can be modified by psychosocial interventions. In this chapter we begin by identifying three key components of resilient responses to chronic pain despite pain: (1) recovery from pain-related decrements in functioning, (2) sustainability of purpose in the face of painful episodes, and (3) psychological growth from learning new and more effective ways to respond to recurrent episodes of moderate to severe arthritis pain. We review current research findings of individual differences in successful adaptation with this model of resilience in mind. Further, we introduce time course as a contributing factor to resilient outcomes, incorporating the role of developmental and situational factors in the initial onset of pain through development of and adjustment to chronic pain. Fatigue, a complex and salient barrier for individuals with chronic pain, is examined as an example of a failure of self-regulation and recovery processes in arthritis. Additionally, the role of goal orientation and reward processing in catalyzing resilient responses to pain is reviewed. Finally, the interpersonal context of pain resilience is examined, with specific attention paid to social contributors to positive emotion, social support, and styles of pain expression.
- "A new approach is needed to widen the scope of these inquiries to characterize the ways and means of positive adaptation. Of late there has been a proliferation of studies devoted to factors that facilitate effective adaptation to chronic pain, commonly referred to as pain resilience (Karoly & Ruehlman, 2006; Ramirez-Maestre, Esteve, & Lopez, 2012; Strand et al., 2006; Sturgeon & Zautra, 2010 A. J. Zautra, Johnson, & Davis, 2005). It is these studies that provide the basis for our review, and provide the foundation for our call for new initiatives to address the problem of pain in the lives of arthritis patients. "
[Show abstract] [Hide abstract] ABSTRACT: Background: Older adults frequently experience physical symptoms of arthritis pain. We examined the dynamic change of arthritis pain and depressive symptoms over time. We also addressed the influence of time varying arthritis pain on depressive symptoms and positive affect among community dwelling older individuals. Methods: Analyses were based on data from 4 annual follow-ups in a sample of 299 elderly residents (M=83.78) of Florida retirement communities. We estimated a hierarchical growth curve model that related the effects of time varying pain and characteristics of participants such as age, gender, cognitive functioning, emotional support and health. Growth curve modeling was used to assess changes in emotional well-being as a function of arthritis pain over time. Results: We found that depressive symptoms increased over 4 years whereas positive affect declined over 4 years with significant between-person differences in levels and slopes. As predicted, changes in arthritis pain co-varied with both depressive symptoms and positive affect over time. Gender, cognitive functioning, health conditions and emotional support from others were associated with between person differences in level of emotional well-being. Conclusions: Our findings suggest that conceptualization of emotional well-being of older adults as a dynamic, changing construct applies both depressive symptoms and positive affect. Findings also suggest that arthritis pain as well as emotional support contribute to depressive symptoms and to positive affect among older adults with arthritis.
- "Moreover, this relation remains significant even when corrected for health and other social resources, which is consistent with earlier findings . The results we found with respect to the effect of pain on positive affect also strengthen the finding of previous studies, as prior studies examining this association often look at the short term relation between positive affect and arthritis pain . In our study, we included a 4 year follow up period assessed at 1 year intervals in a large group of community dwelling older people. "