Skip to main content
SpringerLink
Log in

Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients

  • Published:
Annals of Behavioral Medicine

Abstract

Background: Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life for chronic pain patients.Purpose: This theoretically based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports of positive affect (PA) and negative affect (NA), and the relations of pain severity to both PA and NA.Methods: Participants were women, 36 with osteoarthritis and 86 with fibromylagia, who completed an initial assessment for demographics, pain catastrophizing, and pain acceptance, and 2 to 12 weekly assessments of pain severity, PA, and NA.Results: Multilevel modeling analyses indicated that pain acceptance was related to higher levels of PA but was unrelated to NA. Furthermore, pain acceptance moderated the relation of NA and pain severity, such that expected increases in NA during pain exacerbations were buffered by higher levels of pain acceptance.Conclusions: These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM: Prevalence of chronic benign pain disorder among adults: A review of the literature.Pain. 1998,77:231–239.

    Article  PubMed  CAS  Google Scholar 

  2. Harstall C: How prevalent is chronic pain?Pain: Clinical Updates. 2003,XI:1–4.

    Google Scholar 

  3. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA: The epidemiology of chronic pain in the community.Lancet. 1999,354:1248–1252.

    Article  PubMed  CAS  Google Scholar 

  4. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ: Chronic pain in Australia: A prevalence study.Pain. 2001,89:127–134.

    Article  PubMed  CAS  Google Scholar 

  5. Turk DC: Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.Clinical Journal of Pain. 2002,18:355–365.

    Article  PubMed  Google Scholar 

  6. McCracken LM, Eccleston C: Coping or acceptance: What to do about chronic pain?Pain. 2003,105:197–204.

    Article  PubMed  Google Scholar 

  7. McCracken LM, Spertus IL, Janeck AS, Sinclair D, Wetzel FT: Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance.Pain. 1999,80:283–289.

    Article  PubMed  CAS  Google Scholar 

  8. McCracken LM: Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain.Pain. 1998,74:21–27.

    Article  PubMed  CAS  Google Scholar 

  9. Viane I, Crombez G, Eccleston C, et al.: Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: Empirical evidence and reappraisal.Pain. 2003,106:65–72.

    Article  PubMed  Google Scholar 

  10. Viane I, Crombez G, Eccleston C, Devulder J, De Corte W: Acceptance of the unpleasant reality of chronic pain: Effects upon attention to pain and engagement with daily activities.Pain. 2004,112:282–288.

    Article  PubMed  Google Scholar 

  11. McCracken LM, Eccleston C: A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers.European Journal of Pain. 2006,10:23–29.

    Article  PubMed  Google Scholar 

  12. McCracken LM, Vowles KE, Eccleston C: Acceptance of chronic pain: Component analysis and a revised assessment method.Pain. 2004,107:159–166.

    Article  PubMed  Google Scholar 

  13. McCracken LM, Carson JW, Eccleston C, Keefe FJ: Acceptance and change in the context of chronic pain.Pain. 2004,109:4–7.

    Article  PubMed  Google Scholar 

  14. Zautra AJ, Burleson MH, Smith CA, et al.: Arthritis and perceptions of quality of life: An examination of positive and negative affect in rheumatoid arthritis patients.Health Psychology. 1995,14:399–408.

    Article  PubMed  CAS  Google Scholar 

  15. Zautra A, Smith B, Affleck G, Tennen H: Examinations of chronic pain and affect relationships: Applications of a dynamic model of affect.Journal of Consulting and Clinical Psychology. 2001,69:786–795.

    Article  PubMed  CAS  Google Scholar 

  16. Zautra AJ, Johnson LM, Davis MC: Positive affect as a source of resilience for women in chronic pain.Journal of Consulting and Clinical Psychology. 2005,73:212–220.

    Article  PubMed  Google Scholar 

  17. Turner JA, Aaron LA: Pain-related catastrophizing: What is it?Clinical Journal of Pain. 2001,17:65–71.

    Article  PubMed  CAS  Google Scholar 

  18. Turner JA, Jensen MP, Warms CA, Cardenas DD: Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury.Pain. 2002,98:127–134.

    Article  PubMed  Google Scholar 

  19. Turner JA, Mancl L, Aaron LA: Pain-related catastrophizing: A daily process study.Pain. 2004,110:103–111.

    Article  PubMed  Google Scholar 

  20. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.Psychiatry Research. 1989,28:193–213.

    Article  PubMed  CAS  Google Scholar 

  21. Johnson LM, Zautra AJ, Davis MC: The role of illness uncertainty on coping with fibromyalgia symptoms.Health Psychology. 2006,25:696–703.

    Article  PubMed  Google Scholar 

  22. Reich JW, Johnson LM, Zautra AJ, Davis MC: Uncertainty of illness relationships with mental health and coping processes in fibromyalgia patients.Journal of Behavioral Medicine. 2006,29:307–316.

    Article  PubMed  Google Scholar 

  23. Zautra AJ, Fasman R, Reich JW, et al.: Fibromyalgia: Evidence for deficits in positive affect regulation.Psychosomatic Medicine. 2005,67:147–155.

    Article  PubMed  Google Scholar 

  24. Zautra AJ, Johnson LM, Davis MC: Positive affect as a source of resilience for women in chronic pain.Journal of Consulting and Clinical Psychology. 2005,73:212–220.

    Article  PubMed  Google Scholar 

  25. Geiser DS: A comparison of acceptance-focused and control-focused psychological treatments in a chronic pain treatment center. Doctoral dissertation, University of Nevada: 1992.

  26. Veit CT, Ware JE Jr.: The structure of psychological distress and well-being in general populations.Journal of Consulting and Clinical Psychology. 1983,51:730–742.

    Article  PubMed  CAS  Google Scholar 

  27. Zautra AJ, Guarnaccia CA, Reich JW: Factor structure of mental health measures for older adults.Journal of Consulting and Clinical Psychology. 1988,56:514–519.

    Article  PubMed  CAS  Google Scholar 

  28. Ware JE Jr., Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Medical Care. 1992,30:473–483.

    Article  PubMed  Google Scholar 

  29. Jensen MP, Karoly P, Braver S: The measurement of clinical pain intensity: A comparison of six methods.Pain. 1986,27:117–126.

    Article  PubMed  CAS  Google Scholar 

  30. Watson D, Clark LA, Tellegen A: Development and validation of brief measures of positive and negative affect: The PANAS scales.Journal of Personality and Social Psychology. 1988,54:1063–1070.

    Article  PubMed  CAS  Google Scholar 

  31. Smith CA, Wallston KA, Dwyer KA, Dowdy SW: Beyond good and bad coping: A multidimensional examination of coping with pain in persons with rheumatoid arthritis.Annals of Behavioral Medicine. 1997,19:11–21.

    Article  PubMed  CAS  Google Scholar 

  32. Swartzman LC, Gwadry FG, Shapiro AP, Teasell RW: The factor structure of the Coping Strategies Questionnaire.Pain. 1994,57:311–316.

    Article  PubMed  CAS  Google Scholar 

  33. Ryff CD, Keyes CL: The structure of psychological well-being revisited.Journal of Personality and Social Psychology. 1995,69:719–727.

    Article  PubMed  CAS  Google Scholar 

  34. Smith TW, Christensen AJ, Peck JR, Ward JR: Cognitive distortion, helplessness, and depressed mood in rheumatoid arthritis: A four-year longitudinal analysis.Health Psychology. 1994,13:213–217.

    Article  PubMed  CAS  Google Scholar 

  35. Smith TW, Peck JR, Ward JR: Helplessness and depression in rheumatoid arthritis.Health Psychology. 1990,9:377–389.

    Article  PubMed  CAS  Google Scholar 

  36. Littell R, Milliken G, Stroup W, Wolfinger R:SAS System for Linear Mixed Models. Cary, NC: SAS Institute, 1996.

    Google Scholar 

  37. Diggle PJ, Liang KL, Zeger SL:Analysis of Longitudinal Data. New York: Oxford University Press, 1994.

    Google Scholar 

  38. Huber PJ: The behavior of maximum likelihood estimates under non-standard conditions.Proceedings of the Fifth Berkely Symposium on Mathematical Statistics and Probability. 1967,1:221–233.

    Google Scholar 

  39. White H: A heteroscedasticity-consistent covariance matrix estimator and a direct test for heteroscedasticity.Econometrica. 1980,48:817–830.

    Article  Google Scholar 

  40. Schafer JL, Graham JW: Missing data: Our view of the state of the art.Psychological Methods. 2002,7:147–177.

    Article  PubMed  Google Scholar 

  41. Aiken LS, West SG:Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage, 1991.

    Google Scholar 

  42. Singer JD: Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models.Journal of Educational and Behavioral Statistics. 1998,24:323–355.

    Google Scholar 

  43. Kreft IGG, De Leeuw J, Aiken LS: The effect of different forms of centering on hierarchical linear modeling.Multivariate Behavioral Research. 1995,30:1–21.

    Article  Google Scholar 

  44. Affleck G, Zautra A, Tennen H, Armeli S: Multilevel daily process designs for consulting and clinical psychology: A preface for the perplexed.Journal of Consulting and Clinical Psychology. 1999,67:746–754.

    Article  PubMed  CAS  Google Scholar 

  45. Fredrickson BL, Joiner T: Positive emotions trigger upward spirals toward emotional well-being.Psychological Science. 2002,13:172–175.

    Article  PubMed  Google Scholar 

  46. Zautra AJ:Emotions, Stress, & Health. London: Oxford University Press, 2003.

    Google Scholar 

  47. Stone AA, Broderick JE, Shiffman SS, Schwartz JE: Understanding recall of weekly pain from a momentary assessment perspective: Absolute agreement, between- and within-person consistency, and judged change in weekly pain.Pain. 2004,107:61–69.

    Article  PubMed  Google Scholar 

  48. Redelmeier DA, Kahneman D: Patients’ memories of painful medical treatments: Real-time and retrospective evaluations of two minimally invasive procedures.Pain. 1996,66:3–8.

    Article  PubMed  CAS  Google Scholar 

  49. Stone AA, Broderick JE, Kaell AT, DelesPaul PA, Porter LE: Does the peak-end phenomenon observed in laboratory pain studies apply to real-world pain in rheumatoid arthritics?Journal of Pain. 2000,1:212–217.

    Article  PubMed  CAS  Google Scholar 

  50. Stone AA, Schwartz JE, Broderick JE, Shiffman SS: Variability of momentary pain predicts recall of weekly pain: A consequence of the peak (or salience) memory heuristic.Personality and Social Psychology Bulletin. 2005,31:1340–1346.

    Article  PubMed  Google Scholar 

  51. Cohen J:Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1987.

    Google Scholar 

  52. Hayes SC: Content, context, and the types of psychological acceptance. In Hayes SC (ed),Acceptance and Change: Content and Context in Psychotherapy. Reno, NV: Context Press, 1994.

    Google Scholar 

  53. Hayes SC, Jacobson NS, Follette VM, Dougher MJ:Acceptance and Change: Content and Context in Psychotherapy. Reno, NV: Context Press, 1994.

    Google Scholar 

  54. Hayes SC, Bissett RT, Korn Z, et al.: The impact of acceptance versus control rationales on pain tolerance.The Psychological Record. 1999,48:33–47.

    Google Scholar 

  55. Hayes SC, Wilson KG: Acceptance and commitment therapy: Altering the verbal support for experiential avoidance.The Behavior Analyst. 1994,17:289–303.

    Google Scholar 

  56. Cioffi D, Holloway J: Delayed costs of suppressed pain.Journal of Personality and Social Psychology. 1993,64:274–282.

    Article  PubMed  CAS  Google Scholar 

  57. Goubert L, Crombez G, Eccleston C, Devulder J: Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain.Pain. 2004,110:220–227.

    Article  PubMed  Google Scholar 

  58. Sullivan MJ, Rouse D, Bishop S, Johnston S: Thought suppression, catastrophizing, and pain.Cognitive Therapy and Research. 1997,21:555–568.

    Article  Google Scholar 

  59. Kabat-Zinn J, Lipworth L, Burney R: The clinical use of mindfulness meditation for the self-regulation of chronic pain.Journal of Behavioral Medicine. 1985,8:163–190.

    Article  PubMed  CAS  Google Scholar 

  60. Kabat-Zinn J:Full Catastrophe Living. New York: Delacorte, 1990.

    Google Scholar 

  61. McCracken LM, Vowles KE, Eccleston C: Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase.Behavior Research and Therapy. 2005,43:1335–1346.

    Article  Google Scholar 

  62. Dahl J, Wilson KG, Nilsson A: Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial.Behavior Therapy. 2004,35:785–801.

    Article  Google Scholar 

  63. Hayes SC: Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies.Behavior Therapy. 2004,35:639–665.

    Article  Google Scholar 

  64. Teasdale JD, Moore RG, Hayhurst H, Pope M, Williams S, Segal ZV: Metacognitive awareness and prevention of relapse in depression: Empirical evidence.Journal of Consulting and Clinical Psychology. 2002,70:275–287.

    Article  PubMed  Google Scholar 

  65. Wrosch C, Scheier MF: Personality and quality of life: The importance of optimism and goal adjustment.Quality of Life Research. 2003,12(Suppl. 1):59–72.

    Article  PubMed  Google Scholar 

  66. Schmitz U, Saile H, Nilges P: Coping with chronic pain: Flexible goal adjustment as an interactive buffer against pain-related distress.Pain. 1996,67:41–51.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Anna L. Kratz M.A.

    Present address: Department of Psychology, Arizona State University, P.O. Box 871104, 85287-1104, Tempe, AZ

Authors and Affiliations

  1. Department of Psychology, Arizona State University, P.O. Box 871104, 85287-1104, Tempe, AZ

    Mary C. Davis Ph.D. & Alex J. Zautra Ph.D.

Authors
  1. Anna L. Kratz M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary C. Davis Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alex J. Zautra Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This research was funded by a grant to Alex J. Zautra from the Arthritis Foundation.

About this article

Cite this article

Kratz, A.L., Davis, M.C. & Zautra, A.J. Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients. ann. behav. med. 33, 291–301 (2007). https://doi.org/10.1007/BF02879911

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02879911

Keywords

Search

Navigation