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Pain Matters – Anger, Sad Study Results

Pain matters – not only to the person feeling it – to the whole family. The idea that our own feelings of anger and sadness might increase our pain level mean we could learn to control the anger and sadness, lessening pain and – if it works on the respiratory system – we can lessen and control the breathing rough times.

Could the same Utrecht University study results apply to lung patients?  It seems a strong possibility based on my own recent experience.

For lung patients it’s important to remember that pain pills negatively affect the respiratory system – we can’t just take them as others might, for pain.  Ask your doctor or Pain Center.

The importance of the study may be seen in the next two paragraphs:

“The treatment effects were significant, showing notable positive differences in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM for the TC in comparison with the WLC. Clinically relevant improvement was found among patients in the TC group.

“Our results demonstrate that offering high-risk FM patients a treatment tailored to their cognitive behavioral patterns at an early stage after the diagnosis is effective in improving both short-and long-term physical and psychological outcomes,” says junior investigator Saskia van Koulil. “Supporting evidence of the effectiveness of our tailored treatment was found with regard to the follow-up assessments and the low dropout rates. The effects were overall maintained at 6 months, suggesting that patients continued to benefit from the treatment.””

I asked if they had done a separate study for men and discovered that few men get fibromyalgia and was not included in the study.

“Dr. van Middendorp’s response follows:

There were two reasons why men were not included in this study. First, because of the female preponderance in fibromyalgia. This makes it very difficult to include enough men with fibromyalgia to draw reliable conclusions. Second, because men and women differ in emotions, ways of dealing with their emotions, and in reported and experimental pain levels, they cannot just be regarded as one group. Resultantly, we decided to focus our study on women only. There was not a separate study done in men.”

“Anger amplifies clinical pain in women with and without fibromyalgia –

Sensitizing effect of anger and sadness not limited to fibromyalgia patients”

Researchers from Utrecht University who studied the effect of negative emotions on pain perception in women with and without fibromyalgia found that anger and sadness amplified pain equally in both groups. Full findings are now online and will publish in the October print issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

The Utrecht team theorized that specific negative emotions such as sadness and anger also would increase pain more in women with FM than in healthy women. Their study examined the effects of experimentally-induced anger and sadness on self-reported clinical and experimentally-induced pain in women with and without FM. Participants consisted of 62 women with FM and 59 women without FM. Both groups were asked to recall a neutral situation, followed by recalling both an anger-inducing and a sadness-inducing situation, in counterbalanced order. The effect of these emotions on pain responses (non-induced clinical pain and experimentally-induced sensory threshold, pain threshold, and pain tolerance) was analyzed with a repeated-measures analysis of variance.

Self-reported clinical pain always preceded the experimentally-induced pain assessments and consisted of reporting current pain levels (“now, at this moment”) on a scale ranging from “no pain at all” to “intolerable pain.” Clinical pain reports were analyzed in women with FM only. Electrical pain induction was used to assess experimentally-induced pain. Participants pressed a button when they felt the current (sensory threshold) and when it became painful (pain threshold) and intolerable (pain tolerance). Four pain assessments were conducted per condition, and very high internal consistencies were obtained.

More pain was indicated by both the clinical pain reports in women with FM and pain threshold and tolerance in both groups in response to anger and sadness induction. Sadness reactivity predicted clinical pain responses. Anger reactivity predicted both clinical and electrically-stimulated pain responses.

Both women with and women without FM manifested increased pain in response to the induction of both anger and sadness, and greater emotional reactivity was associated with a greater pain response. “We found no convincing evidence for a larger pain response to anger or sadness in either study group (women with, or without FM), said study leader Henriët van Middendorp, Ph.D. “In women with FM, sensitivity was roughly the same for anger and sadness.”

Dr. van Middendorp concludes, “Emotional sensitization of pain may be especially detrimental in people who already have high pain levels. Research should test techniques to facilitate better emotion regulation, emotional awareness, experiencing, and processing.”

In a related study, a research team from Radboud University Nijmegen Medical Centre found that tailored cognitive-behavioral therapy (CBT) and exercise training tailored to pain-avoidance or pain-persistence patterns at a relatively early stage after diagnosis is likely to promote beneficial treatment outcomes for high-risk patients with FM.

The Nijmegen team evaluated the effects of this approach in a randomized controlled trial. The study compared a waiting list control condition (WLC) with patients in a treatment condition (TC) to demonstrate improvements in physical and psychological functioning and in the overall impact of FM.

High-risk patients were selected and classified into 2 groups (84 patients were assigned to a pain-avoidance group and 74 patients to the pain-persistence group) and subsequently randomized to either the TC or WLC. Treatment consisted of 16 sessions of CBT and exercise training, tailored to the patient’s specific cognitive behavioral pattern, delivered within 10 weeks. Physical and psychological functioning and impact of FM were assessed at baseline, post-treatment, and 6-month follow-up.

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These studies are published in Arthritis Care & Research. Media wishing to receive a PDF of these articles may contact healthnews@wiley.com.

Full Citation: “The Effects of Anger and Sadness on Clinical Pain Reports and Experimentally-Induced Pain Thresholds in Women With and Without Fibromyalgia.” Henriët van Middendorp, Mark A. Lumley, Johannes W.G. Jacobs, Johannes W.J. Bijlsma, Rinie Greenen. Arthritis Care and Research; Published Online: April 21, 2010 (DOI: 10.1002/acr.20230); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/acr.20230/abstract

“Tailored Cognitive-Behavioral Therapy and Exercise Training for High-Risk Patients With Fibromyalgia.” Saskia van Koulil, Wim van Lankveld, Floris W. Kraaimaat, Toon van Helmond, Annemieke Vedder, Hanneke van Hoorn, Rogier Donders, Alphons J.L. De Jong, Joost F. Haverman, Kurt-Jan Korff, Piet L.C.M. van Riel, Hans A. Cats, Andrea W.M. Evers. Arthritis Care and Research; Published Online: June 2, 2010 (DOI: 10.1002/acr.20268); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/acr.20268/abstract

Arthritis Care & Research is an official journal of the American College of Rheumatology, and the Association of Rheumatology Health Professionals, a division of the College.

Thank you, Dawn Peters, for your assistance!

Part 2 of 2

More later…. Sharon O’Hara

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