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Depressive Symptoms and Momentary Mood Predict Momentary Pain Among Rheumatoid Arthritis Patients

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Although a relationship between mood and pain has been established cross-sectionally, little research has examined this relationship using momentary within-person data.

Purpose

We examined whether baseline depressive symptoms and within-person levels of negative and positive mood predicted momentary pain among 31 individuals with rheumatoid arthritis (RA).

Methods

Depressive symptomatology was measured at baseline. Mood and RA symptoms were self-reported via ecological momentary assessment five times a day for seven consecutive days. Analyses controlled for gender, age, weekend day, time of day, and experiences of stress.

Results

Greater momentary positive mood was associated with less momentary pain and fewer arthritis-related restrictions; negative mood was associated with more restrictions. Greater depressive symptomatology also predicted more pain and restrictions, an effect which was not accounted for by mood.

Conclusions

Results suggest that both depression and mood are uniquely associated with momentary pain; as such, multi-component interventions may provide optimal disease management.

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References

  1. Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychol Bull. 1996; 119: 95-110.

    Article  Google Scholar 

  2. Keefe FJ, Somers TJ. Psychological approaches to understanding and treating arthritis pain. Nat Rev Rheumatol. 2010; 6: 210-216.

    Article  PubMed  Google Scholar 

  3. Huyser BA, Parker JC. Negative affect and pain in arthritis. Rheum Dis Clin North Am. 1999; 25: 105-121.

    Article  CAS  PubMed  Google Scholar 

  4. Khurana R, Berney SM. Clinical aspects of rheumatoid arthritis. Pathophysiology. 2005; 12: 153-165.

    Article  PubMed  Google Scholar 

  5. Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosom Med. 2002; 64: 52-60.

    Article  PubMed  Google Scholar 

  6. Cannella DT, Lobel M, Glass P, Lokshina I, Graham JE. Factors associated with depressed mood in chronic pain patients: The role of personal coping resources. J Pain. 2007; 8: 256-262.

    Article  PubMed  Google Scholar 

  7. Zautra AJ, Smith B, Affleck G, Tennen H. Examinations of chronic pain and affect relationships: Applications of a dynamic model of affect. J Consult Clin Psychol. 2001; 69: 786.

    Article  CAS  PubMed  Google Scholar 

  8. Campbell LC, Clauw DJ, Keefe FJ. Persistent pain and depression: A biopsychosocial perspective. Biol Psychiatry. 2003; 54: 399-409.

    Article  PubMed  Google Scholar 

  9. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: A literature review. Arch Intern Med. 2003; 163: 2433.

    Article  PubMed  Google Scholar 

  10. Gaskin ME, Greene AF, Robinson ME, Geisser ME. Negative affect and the experience of chronic pain. J Psychosom Res. 1992; 36: 707-713.

    Article  CAS  PubMed  Google Scholar 

  11. Evers AW, Verhoeven EW, van Middendorp H, et al. Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptom fluctuations in rheumatoid arthritis. Ann Rheum Dis. 2014; 73: 1683-1688.

    Article  CAS  PubMed  Google Scholar 

  12. Strand EB, Kerns RD, Christie A, et al. Higher levels of pain readiness to change and more positive affect reduce pain reports: A weekly assessment study on arthritis patients. Pain. 2007; 127: 204-13.

    Article  PubMed  Google Scholar 

  13. Smith B, Zautra AJ. The effects of anxiety and depression on weekly pain in women with arthritis. Pain. 2008; 138: 354-361.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Zautra AJ, Johnson LM, Davis MC. Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol. 2005; 73: 212-220.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Connelly M, Keefe FJ, Affleck G, et al. Effects of day-to-day affect regulation on the pain experience of patients with rheumatoid arthritis. Pain. 2007; 131: 162-170.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Gil KM, Carson JW, Porter LS, et al. Daily mood and stress predict pain, health care use, and work activity in African American adults with sickle-cell disease. Health Psychol. 2004; 23: 267-274.

    Article  PubMed  Google Scholar 

  17. Finan PH, Quartana PJ, Smith MT. Positive and negative affect dimensions in chronic knee osteoarthritis: Effects on clinical and laboratory pain. Psychosom Med. 2013; 75: 463-470.

    Article  CAS  PubMed  Google Scholar 

  18. Smyth JM, Heron KE. Health psychology. In: Mehl MR, Conner TS, eds. Handbook of Research Methods for Studying Daily Life. New York: The Guilford Press; 2012: 569-584.

    Google Scholar 

  19. Sorbi MJ, Peters ML, Kruise DA, et al. Electronic momentary assessment in chronic pain I: Psychological pain responses as predictors of pain intensity. Clin J Pain. 2006; 22: 55-66.

    Article  PubMed  Google Scholar 

  20. Clark LA, Watson D. Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. J Abnorm Psychol. 1991; 100: 316-336.

    Article  CAS  PubMed  Google Scholar 

  21. Smith B, Zautra AJ. Vulnerability and resilience in women with arthritis: Test of a two-factor model. J Consult Clin Psychol. 2008; 76: 799-810.

    Article  PubMed  Google Scholar 

  22. Hamilton NA, Zautra AJ, Reich JW. Affect and pain in rheumatoid arthritis: Do individual differences in affective regulation and affective intensity predict emotional recovery from pain? Ann Behav Med. 2005; 29: 216-224.

    Article  PubMed  Google Scholar 

  23. Benedetti F, Amanzio M. Mechanisms of the placebo response. Pulm Pharmacol Ther. 2013; 26: 520-523.

    Article  CAS  PubMed  Google Scholar 

  24. Koepp MJ, Hammers A, Lawrence AD, et al. Evidence for endogenous opioid release in the amygdala during positive emotion. Neuroimage. 2009; 44: 252-256.

    Article  CAS  PubMed  Google Scholar 

  25. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005; 131: 925-971.

    Article  PubMed  Google Scholar 

  26. Strand EB, Zautra AJ, Thoresen M, et al. Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. J Psychosom Res. 2006; 60: 477-484.

    Article  PubMed  Google Scholar 

  27. Affleck G, Tennen H, Urrows S, Higgins P. Person and contextual features of daily stress reactivity: Individual differences in relations of undesirable daily events with mood disturbance and chronic pain intensity. J Pers Soc Psychol. 1994; 66: 329-340.

    Article  CAS  PubMed  Google Scholar 

  28. DeLongis A, Folkman S, Lazarus R. The impact of daily stress on health and mood: Psychological and social resources as mediators. J Pers Soc Psychol. 1988; 54: 486-495.

    Article  CAS  PubMed  Google Scholar 

  29. Smyth JM, Zawadzki MJ, Santuzzi AM, Filipkowski KB. Examining the effects of perceived social support on momentary mood and symptom reports in asthma and arthritis patients. Psychol Health. 2014; 29: 813-831.

    Article  PubMed  Google Scholar 

  30. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385-401.

    Article  Google Scholar 

  31. Turk DC, Okifuji A. Detecting depression in chronic pain patients: Adequacy of self-report. Behav Res Ther. 1994; 32: 9-16.

    Article  CAS  PubMed  Google Scholar 

  32. Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies Depression Scale and the Beck Depression Inventory: A comparative analysis. Clin J Pain. 1997; 13: 163-170.

    Article  CAS  PubMed  Google Scholar 

  33. Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain. 2003; 104: 627-637.

    Article  PubMed  Google Scholar 

  34. Wilhelm P, Schoebi D. Assessing mood in daily life: Structural validity, sensitivity to change, and reliability of a short-scale to measure three basic dimensions of mood. Eur J Psych Assess. 2007; 23: 258-267.

    Article  Google Scholar 

  35. Pincus T, Strand V, Koch G, et al. An index of the three core data set patient questionnaire measures distinguishes efficacy of active treatment from that of placebo as effectively as the American College of Rheumatology 20% response criteria (ACR20) or the Disease Activity Score (DAS) in a rheumatoid arthritis clinical trial. Arthritis Rheum. 2003; 48: 625-630.

    Article  CAS  PubMed  Google Scholar 

  36. Schwartz JE, Stone AA. Strategies for analyzing ecological momentary assessment data. Health Psychol. 1998; 17: 6-16.

    Article  CAS  PubMed  Google Scholar 

  37. Singer J, Willett J. Applied Longitudinal Data Analysis. New York: Oxford University Press; 2003.

    Book  Google Scholar 

  38. Zhang Z, Zyphur MJ, Preacher KJ. Testing multilevel mediation using hierarchical linear models problems and solutions. Org Res Meth. 2009; 12: 695-719.

    Article  Google Scholar 

  39. Krull JL, MacKinnon DP. Multilevel modeling of individual and group level mediated effects. Multivar Behav Res. 2001; 36: 249-277.

    Article  CAS  Google Scholar 

  40. Lewis M, Haviland-Jones JM, Barrett LF. Handbook of Emotions. 3rd ed. New York, NY: Guilford Press; 2008.

    Google Scholar 

  41. Wenze SJ, Gunthert KC, German RE. Biases in affective forecasting and recall in individuals with depression and anxiety symptoms. Pers Soc Psychol Bull. 2012; 38: 895-906.

    Article  PubMed  Google Scholar 

  42. Bradley B, Mathews A. Negative self-schemata in clinical depression. Br J Clin Psychol. 1983; 22: 173-181.

    Article  PubMed  Google Scholar 

  43. Staiger TO, Gaster B, Sullivan MD, Deyo RA. Systematic review of antidepressants in the treatment of chronic low back pain. Spine. 2003; 28: 2540-2545.

    Article  PubMed  Google Scholar 

  44. Kothari DJ, Davis MC, Yeung EW, Tennen HA. Positive affect and pain: Mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia. Pain. 2015; 156: 540-546.

    Article  PubMed  Google Scholar 

  45. Janssen SA. Negative affect and sensitization to pain. Scand J Psychol. 2002; 43: 131-137.

    Article  PubMed  Google Scholar 

  46. Eisenberger NI: Meta-analytic evidence for the role of the anterior cingulate cortex in social pain. Soc Cogn Affect Neurosci. 2014.

  47. Shackman AJ, Salomons TV, Slagter HA, et al. The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci. 2011; 12: 154-167.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Wager TD, Kang J, Johnson TD, et al. A bayesian model of category-specific emotional brain responses. PLoS Comput Biol. 2015; 11: e1004066.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Carroll JE, Low CA, Prather AA, et al. Negative affective responses to a speech task predict changes in interleukin (IL)-6. Brain Behav Immun. 2011; 25: 232-238.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Dickerson SS, Kemeny ME, Aziz N, Kim KH, Fahey JL. Immunological effects of induced shame and guilt. Psychosom Med. 2004; 66: 124-131.

    Article  CAS  PubMed  Google Scholar 

  51. Goodin BR, Anderson AJ, Freeman EL, et al. Intranasal oxytocin administration is associated with enhanced endogenous pain inhibition and reduced negative mood states. Clin J Pain. 2014; doi:10.1097/AJP.0000000000000166

  52. Heron KE, Smyth JM. Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010; 15: 1-39.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Damaske S, Smyth JM, Zawadzki MJ. Has work replaced home as a haven? Re-examining Arlie Hochschild's Time Bind proposition with objective stress data. Soc Sci Med. 2014; 115: 130-138.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This research was supported by a grant from the National Heart, Lung, and Blood Institute (R01-HL067990) to Smyth. Work on this manuscript was also supported in part by a National Science Foundation Graduate Research Fellowship Program (DGE1255832) to Slavish. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Institutes of Health or the National Science Foundation.

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Authors

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Correspondence to Jennifer E. Graham-Engeland Ph.D. or Joshua M. Smyth Ph.D..

Supplementary Materials

Below is the link to the electronic supplementary material.

Supplemental 1

Unstandardized estimates (standard errors) for within-person positive and negative mood predicting within-person pain and restrictions. (DOC 34 kb)

Supplemental 2

Unstandardized estimates (standard errors) for within-person positive mood and negative mood mediating the effect of depressive symptoms on within-person pain and restrictions. (DOC 34 kb)

Supplemental 3

Unstandardized estimates (standard errors) for within-person positive and negative mood mediating the effect of depressive symptoms on lagged within-person pain and restrictions. (DOC 42 kb)

Supplemental 4

Unstandardized estimates (standard errors) for within-person positive and negative mood predicting within-person pain and restrictions by clinical depression. (DOC 40 kb)

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Graham-Engeland, J.E., Zawadzki, M.J., Slavish, D.C. et al. Depressive Symptoms and Momentary Mood Predict Momentary Pain Among Rheumatoid Arthritis Patients. ann. behav. med. 50, 12–23 (2016). https://doi.org/10.1007/s12160-015-9723-2

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  • DOI: https://doi.org/10.1007/s12160-015-9723-2

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