Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery

OBJECTIVE: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. DESIGN AND MEASURES: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. CONCLUSIONS: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning.     

Evidence Supporting an Independent Association between Childhood Physical Abuse and Lifetime Suicidal Ideation

A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.     

Fibromyalgia in men and women: comparison of the main clinical symptoms

The prevalence of fibromyalgia (FM) in males is much lower than in women. Thus, current knowledge about the syndrome has been developed from research with women. The aim of the present study is to analyze whether FM manifestations differ as a function of sex. Two clinical groups with FM (21 males and 21 women) and a control group of healthy men (n= 21) participated in the study. Several aspects of pain, sleep, fatigue, psychopathology, emotional distress and functional impact of FM were evaluated with an algometer and questionnaires. The clinical groups showed a significantly greater impairment than the control group in all the self-report measures. However, the FM patients only showed significant differences in the sensibility threshold to the pain, which was lower in the women. In addition, the best predictor of the experience of pain in males was sleep quality, and in the women, catastrofying pain. Our results suggest that the most effective therapeutic strategies to control pain may be different for men and women.     

Sex Differences in the Presentation of Chronic Low Back Pain

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported more pain and less activity than retired men. Retired men reported the least pain of any group. Outdoor work and social activities show opposite within–group patterns for men and women when stratified by employment status. Marriage was associated with more household work for women and less for men. The financial and social contexts of employment status and marriage are different for men and women. Results suggest the treatment of women with chronic low back pain requires attention to work in the home and the financial and social context of work outside the home.     

Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis

This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8-year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8-year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.     

Under Pressure: Differentiating Adolescents’ Expectations Regarding Stereotypic Masculine and Feminine Behavior

The present study provided a novel way to compare the pressure felt by adolescents to engage in same gender behavior and other gender behavior. A new scale of felt pressure was developed which measured the reactions participants anticipated from others if they were to engage in masculine or feminine stereotyped behaviors. The scale was tested on a sample of 297 Australian adolescents between the ages of 12 and 17. Factor analysis indicated two factors which corresponded to Masculine-Typed and Feminine-Typed behaviors. Items related to feminine-typed behaviors were designated as same gender for young women and other gender for young men, and vice versa for masculine-typed items. Analyses indicated that young men reported higher felt pressure to conform to same gender behavior than did young women, and young women reported felt pressure to conform to other gender behavior whereas young men reported pressure to avoid other gender behavior. In addition, high same gender felt pressure was associated with higher self-perceived same gender typicality and lower other gender typicality. Conversely, high other gender felt pressure was associated with high levels of other gender typicality and lower levels of same gender typicality. The presence of same and other gender felt pressure encourages theorists and practitioners to be mindful of the impact of both these influences on adolescents’ gender identity development and psychosocial adjustment.

     

Personal Control in Chronic Pain Sufferers During Acute Interpersonal Stress

Among individuals with Rheumatoid Arthritis (RA), pain-associated stress can severely impact wellbeing. Psychological attributes, such as a sense of personal mastery, may attenuate the effects of chronic pain on life quality. We tested the hypothesis that a high sense of mastery would predict lower pain, perceived stress, fatigue, and mean arterial pressure (MAP) than would a low sense of mastery during an acute, interpersonal stressor.Seventy-four individuals with RA completed a psychophysiological laboratory session involving MAP measurements, as well as self-ratings of stress, joint pain, and fatigue. Measurements were collected before, during, and after an interpersonal stressor. To assess personal mastery, exploratory and confirmatory factor analyses were conducted on the Pearlin Mastery Scale based on recommendations by Reich and Zautra (1991)The Pearlin Mastery Scale yielded two distinct factors: fatalism and control. Both fatalism and control were significant predictors of the wellbeing variables. Individuals with a highly fatalistic style demonstrated higher general levels of mean arterial pressure (F(1) = 3.41, p<.1) and reported greater joint pain (F(1) = 4.72, p<.05) across all periods. Individuals with a high sense of control also evidenced lower MAP (F(1) = 3.73, p<.1) and reported less stress (F(1) = 7.44, p<.01) and fatigue (F(1) = 5.16, p<.05). Neither fatalism nor control were related to objective measures of disease severity (r's = -.10, p=NS and -.02, p=NS, respectively).RA patients with a high level of personal mastery, as evidenced by scores on two distinct indices, experience lower MAP, and report less pain, stress and fatigue. Although fatalism and control were not related to objective disease state, they seem to play an important role in the experience of wellbeing for people with RA.     

Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms?

Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.     

Women’s Experience of Telehealth Cancer Genetic Counseling

Telegenetics offers an alternative model of delivering genetic counseling to rural and outreach areas; however there is a dearth of qualitative research into the patient’s experience. Twelve women who had received telemedicine genetic counseling for hereditary breast and/or ovarian cancer (HBOC) within the previous 12 months participated in a semi-structured telephone interview. The interview explored women’s experience with telegenetics, satisfaction, perceived advantages and disadvantages and quality of the interaction with their genetic professionals. Overall women were highly satisfied with telegenetics. Telegenetics offered them convenience and reduced travel and associated costs. The majority of women described feeling a high degree of social presence, or rapport, with the off-site genetic clinician. One woman with a recent cancer diagnosis, reported that telemedicine was unable to meet her needs for psychosocial support. This finding highlights the need to be mindful of the psychosocial support needs of women with a recent diagnosis being seen via telegenetics. Patients attending for HBOC genetic counseling are generally highly satisfied with the technology and the interaction. Care should be taken, however, with patients with more complex psychosocial needs.     

Does Feeling Empathy Lead to Compassion Fatigue or Compassion Satisfaction? The Role of Time Perspective

Research has shown that feeling empathy sometimes leads to compassion fatigue and sometimes to compassion satisfaction. In three studies, participants recalled an instance when they felt empathy in order to assess the role time perspective plays in how empathizers perceive the consequences of empathy. Study 1 revealed that college students perceive empathy as having more negative consequences in the short term, but more positive consequences in the long term. Study 2 showed that service industry professionals perceive the consequences of feeling empathy for customers who felt bad as less negative, and the consequences of feeling empathy for people who felt good as less positive, in the long as opposed to the short term. Because Studies 1 and 2 confounded time perspective with event specificity a third study was conducted in which event specificity was held constant across time perspectives. The same pattern of results emerged. The results of these studies indicate that perceptions of the effects of feeling empathy, whether positive or negative, become less extreme over time. These findings shed light on the relation between empathy and compassion fatigue and satisfaction by suggesting that situations that initially are experienced as stressful can over time make the empathizer stronger.     

Physical health 25 years later: the predictive ability of neuroticism

OBJECTIVE: Neuroticism, a personality trait related to distress and emotional stability, is often correlated with physical symptoms and disease presence. Theorists have posited that chronic emotional instability creates physiological changes detrimental to health, yet most findings are based on cross-sectional analyses. The objective of the current study was to examine neuroticism assessed in 1973 and the likelihood of reporting physical conditions 25 years later. DESIGN: Participants included 21676 adult twins (n = 8143 intact twin pairs) ranging from 15 to 47 years old in 1973 who were assessed again between 1998 and 2002. MAIN OUTCOME MEASURES: Thirteen physical conditions, including chronic fatigue syndrome, ulcers, and coronary heart disease, were selected based on their prior theoretical and empirical links to personality traits. RESULTS: Results indicate that the likelihood of having a physical condition is related to higher levels of prior neuroticism, with some associations attenuated when controlling for familial similarity. CONCLUSION: Familial influences are most pronounced for conditions most related to systemic pain, suggesting genetic pathways between neuroticism and these pain experiences.     

Genetic factors in neuromuscular pain

Recent evidence suggests that fibromyalgia, a chronic widespread pain condition and related syndromes (chronic fatigue syndrome, irritable bowel syndrome, etc.) may share heritable pathophysiologic features. We review the recent literature on genetic and familial factors found to participate in the pathogenesis of these syndromes, specifically fibromyalgia, including evidence suggesting that serotonin- and dopamine-related genes may play a role in the pathogenesis of these illnesses. The importance of environmental factors triggering these conditions in predisposed individuals is also discussed.     

Changes in Feeling States Following Aquatic Exercise During Pregnancy

Forty-four pregnant women participated in water aerobics 2 times per week for a period of 6 weeks, with each session lasting approximately 45 min. The hypothesis that participants would report greater feelings of positive well-being and less psychological distress and fatigue during the 6-week program as compared to preprogram reports was supported. Also supporting our hypothesis, similar improvements were noted following a single bout of exercise during each week of the program. Taken together, the results of the present study suggest that regular engagement in an aquatic exercise program is associated with improvements in positive feeling states and reductions in negative feeling states and fatigue for women during pregnancy.     

Identification with arts‐based groups improves mental wellbeing in adults with chronic mental health conditions

People experiencing chronic mental health conditions (CMHC) often report feeling socially marginalised. There is emerging evidence that social and mental wellbeing can be enhanced through participation in arts‐based programmes. In this paper, a social identity theoretical approach was applied to explore how participation in the arts may improve mental health in a longitudinal study. A one‐year prospective study of 34 choir members and 25 creative writing group members (M_age = 46, 51% female) with CMHC, involved three assessments of participants’ group identification and mental wellbeing, measured by the Warwick Edinburgh Mental Wellbeing Scale. The programmes were community‐based and facilitated by arts professionals. Multilevel modelling analyses demonstrated that participants’ mental wellbeing significantly improved over time. Greater identification with their arts‐based group (ABG) was significantly related to an increased rate of improvement in mental wellbeing. The trajectory of improvement in mental wellbeing did not differ between participants partaking in the choir or creative writing group. This study demonstrates that participation in ABGs can be effective in improving mental wellbeing in adults with chronic mental health problems, particularly for those who strongly identify with the group. This study supports ABG participation as an accessible component of mental health services.     

Ethnicity in America and feeling "American"

Ethnic group acculturation remains a concern in the United States today. In the present study, the authors explored the extent to which members of three ethnic groups (White American women, African American women, and Cuban American women) perceived themselves to be "American," how much each group felt that its members were perceived as being American by White Americans, and how these perceptions related to beliefs about their own group's economic and social status. The results showed that African Americans felt American but felt that they were not perceived as such by White Americans. African Americans also reported feeling economically and socially excluded. In contrast, Cuban Americans reported neither feeling they were American nor believing they were perceived as such by White Americans, but feelings of inclusion increased with length of residence. Implications of these results for the common ingroup identity model are discussed.     

Psychiatric and psychological aspects of chronic pain

To gain a better understanding and a more complete assessment of chronic pain syndrome, the psychosocial, psychological, psychodynamic, and psychiatric aspects of this condition should be included in patient evaluation. As illustrated in the two case studies presented, this approach leads to clearer recognition of the biological and psychosocial needs of patients, and allows for more effective treatment measures to be taken.     

Success and Failure, Gender Differences, and the Menstrual Cycle

Eighty-one women and 26 men were led to succeed or fail at a task. No differences in actual performance were found between men and women or among women in different menstrual phases. Although they had participated alone, women felt worse, less competent, and less "up" than men after both success and failure. After success women also felt less satisfied, felt they had made lower scores, expected to perform worse, and rewarded themselves less than men. After success, women who were menstruating at the time of the experiment reported feeling better than women in other menstrual phases on most measures. A possible explanation was that menstruating women may have expected to perform poorly.     

Somatization,sensitization, and functional dyspepsia

Functional dysepsia (FD) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Visceral hypersensitivity, motor dysfunction, and impaired gastric accommodation are found in some patients with FD, and psychological factors like chronic stress, attention and perception bias are also likely to play a part in the symptom formation. There is considerable overlap of non-specific symptoms like fatigue, headache, abdominal discomfort, muscle pain, and sleep disturbance in patients with different functional disorders, in this article exemplified by FD, fibromyalgia, and chronic fatigue syndrome. This overlap of symptoms indicates a common underlying sensitization process, leading to somatization.     

The biopsychosocial approach to chronic pain: scientific advances and future directions

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.     

Applying Cluster Analysis to Define a Typology of Chronic Fatigue Syndrome in a Medically-Evaluated,Random Community Sample

This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with chronic fatigue syndrome and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with chronic fatigue syndrome. Three clusters emerged. Cluster 1 contained only one participant with chronic fatigue syndrome and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with chronic fatigue syndrome and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with chronic fatigue syndrome, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.