Tag Archives: fibromyalgia

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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Train the Brain? Reconsider the Pills?

The headline caught my eye…Anger amplifies clinical pain in women with and without fibromyalgia

I wondered if anger could choke off breathing as well. The researchers from Utrecht University in the Netherlands touched a chord…

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…”

The other day I read a post causally commenting on the list of medications the poster takes.   When I read ‘antianxiety’ pills, I wondered how anyone could take a pill when they are virtually helpless – seemingly in the middle of an anxiety attack.

A few weeks ago, I could no more have reached for a pill than fly to the moon with or without gossamer wings.

Tuesday, 31 August I had a doctor appointment.  Already extremely short of breath a day or two – by the time I dressed and dragged myself up into the back seat of the roomy gas guzzler I was angry and disgusted.   Gasping for air, weak, unable to move beyond a slight shift in position and braced against the side of the car door and the back seat of the car, I didn’t have enough air to purse lip breathe.  (PLB) This was new stuff.

My husband had set up the stepper he’d made me to help get in the car and waited in the driver’s seat until I’d gotten myself in, pulled the stepper in and shut the car door.

The more I struggled to maneuver myself into the car, the angrier and more short of breathe.  Slumped inside and in trouble I couldn’t breathe or talk.

My husband sat in the driver’s seat and drove off.  I couldn’t tell him to take me to the hospital… I couldn’t talk. There was no way to communicate to him that I was in trouble.  The only thing I had that could move was my mind.

Physically helpless my brain raced to hang on to something – anything.  Touches of memory flitted by and were lost. I couldn’t hang on – until the memory of a toilet suspended over a ravine tickled my memory.  The toilet was off to the right of the trail I was riding on.  The memory touched my mind and.  I grabbed hold and felt again the feeling of surprise and absurdity of seeing a toilet high in the Cascades.

I grabbed that memory and felt again the warm and windless Cascade mountain afternoon.  I felt the warm sweat of Wixi’s neck and inhaled her sweet horse smell when I patted her and dismounted to take a closer look and a picture.

The halter rope felt pliable and soft coiled in my hand.  The worn smooth edges of the leather reins slid through my fingers until I had enough rein to loop the ends around the saddle horn of my old roping saddle.

My mind pulled to relive every feeling and sight of that toilet set on the edge of space off a trail high in the Cascade mountain range.  It sat out on the edge of a ravine overlooking space.  Across the ridge, you could see the trail as it came around a bend and then disappeared again off to the right.

Focusing around that memory allowed me to breathe again.

Whoever hauled that toilet in – thanks for the memory.

It is a twenty minute drive to my doctor’s office.  At some point during that drive, I began breathing again.

It is strange how desperation can pull past training up without conscious thought.

Focusing my mind to grab a memory and recall the sights, sound, smell in detail was something I’d learned during a week-end seminar more than thirty years ago.  Lou Tice’s, Pacific Institute affirmation training saved the day.

Thanks Lou.

If that experience was an anxiety attack, a pill couldn’t have helped.  I was helpless to move anything or to swallow if I had a pill to take.

Our minds are available year around.  Maybe we should be trained to use our brain.

September is Pain Awareness Month

What does anger and pain have to do with women?  Lots it seems, with or without fibromyalgia.

Part 1 of 2   More later… Sharon O’Hara

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