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
Could the same Utrecht University study results apply to lung
patients? It seems a strong possibility based on my own
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
The importance of the study may be seen in the next two
“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
“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
Sensitizing effect of anger and sadness not limited to
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
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.
These studies are published in Arthritis Care & Research.
Media wishing to receive a PDF of these articles may contact
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.
“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
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