The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis

Psycho-physiological impact on women with chronic fatigue syndrome in the context of their couple relationship

The quality of dyadic adjustment is likely to play an important role in patients' relational problems and may also be associated with the clinical presentation of chronic fatigue syndrome (CFS) symptoms. The objective of this study was (1) to determine whether CFS patients and their partners have similar perceptions of their dyadic adjustment and (2) to evaluate whether the influence of dyadic satisfaction in women with CFS, as well as common psychological parameters such as anxiety, may correlate with physiological responses at rest and/or when performing very low intensity exercise. Forty females with CFS and their partners completed the Dyadic Adjustment Scale, the State-Trait Anxiety Inventory, and the Hospital Anxiety and Depression scale. The cardiovascular adaptation of patients was evaluated during resting conditions and on a precalibrated cycle ergometer while performing very low intensity exercise. Patients and partners had similar perceptions of their marital relationship. Both at rest and during very low workload, various physiological parameters in the patient group showed statistical correlations with certain psychological parameters. Several psychological variables, such as anxiety and dyadic adjustment, were associated with the cardioventilatory response monitored at rest and during very low intensity exercise. Further studies are needed to determine the nature of this association.

Stress and resilience in rheumatic diseases: a review and glimpse into the future

Stress resilience factors, and interventions to ease stress and enhance resilience, are gaining increasing attention for the treatment of rheumatic conditions. This Review presents a digest of empirical work on the factors that determine the risk of adapting poorly to a rheumatic condition, and on the resilience factors that counteract such risks. We consider the types of stress-management and resilience treatments that are most effective in promoting the physical and psychological functioning of patients at risk of long-term adjustment problems. Prospective research shows that cognitive-behavioral and social risk and resilience factors predict the long-term physical and psychological functioning of patients with rheumatic conditions. Furthermore, validated screening instruments are becoming increasingly useful in clinical practice to identify and select patients at risk. Stress-management and resilience interventions offer promising ways to improve the long-term functioning of patients. These treatment methods might be especially useful when they are tailored to the specific risk and resilience factors of patients, and when they incorporate innovative approaches to the delivery of services, including internet applications such as eHealth, to increase efficiency and availability of treatments, and to optimize patient empowerment in rheumatic conditions.

Goal conflict, distress, and pain in women with fibromyalgia: a daily diary study

OBJECTIVES

A chronic illness such as fibromyalgia can interfere with daily activities and goals by limiting available resources, including time and energy. This leads to competition between goals, known as goal conflict. The purpose of this study was to determine if goal conflict increases symptoms in women with fibromyalgia and whether symptoms lead to perceptions of goal conflict.

METHODS

Women with fibromyalgia (N=27) recorded their pain, emotional distress, and fatigue each morning and evening for five consecutive days. Each evening, they listed that day's goals, rating goals on their level of conflict. Goal conflict was also rated by independent raters, and a difference score reflected goal conflict discrepancy.

RESULTS

On days with higher goal conflict, pain increased more from morning to evening (γ=1.71, 95% confidence interval=0.32-3.09, P<.05). On days with higher morning emotional distress, goal conflict was overestimated (γ=0.075, 95% confidence interval=0.035-0.116, P<.05). Women who had a higher symptom burden also typically overestimated their goal conflict relative to those with fewer symptoms (P<.05 for all).

CONCLUSIONS

Goal pursuit may deplete psychological and physical resources in this vulnerable population, resulting in higher pain. Conversely, emotional distress may affect perception of goal conflict, resulting in less ambitious goal pursuit. Understanding the dynamic relationship between goal conflict and fibromyalgia symptoms may lead to more effective management of limited resources and pursuit of daily goals with fibromyalgia.

Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients

OBJECTIVE

The purpose of this study was to examine the interaction of daily concurrent positive interpersonal events (PIE) and negative interpersonal events (NIE) on the daily experience of negative affect and fatigue in a sample of men and women with rheumatoid arthritis. Two hypotheses were made. The blunting hypothesis predicted that NIE would nullify the beneficial influence of PIE on outcome measures, and the buffering hypothesis predicted that PIE would offset the adverse influence of NIE.

DESIGN

Participants completed up to 30 consecutive daily diaries. Multilevel modeling was used to examine the day-to-day dependencies among study variables.

MAIN OUTCOME MEASURES

The primary outcomes were daily negative affect and fatigue.

RESULTS

In support of the blunting hypothesis, on days when NIE were diminished, PIE were associated with a greater reduction in fatigue. In contrast, consistent with the buffering hypothesis, on days when PIE were elevated, NIE were associated with a lesser increase in negative affect.

CONCLUSION

The examination of concurrent PIE and NIE provides a unique perspective on the role of interpersonal events in affective and physiological outcomes, beyond that which can be gained from the examination of either type of event in isolation.

The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis

OBJECTIVE

To evaluate subjective sleep quality and its relationship to fatigue in older adults with osteoarthritis (OA).

METHOD

In a community cohort with hip/knee OA, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and fatigue was measured by the Profile of Mood States - Fatigue subscale (POMS-F). Correlates of sleep quality and fatigue were determined by standardized interviews including socio-demographics, OA severity (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) summary score), comorbidity, depression (Center for Epidemiologic Studies Depression Scale, CES-D), stressful life events, daytime napping, symptoms of restless legs syndrome (RLS) and prior sleep disorder diagnoses. Logistic regression examined correlates of poor sleep (PSQI score>5). Linear regression evaluated the relationship between poor sleep and fatigue, and the effect of napping on this relationship.

RESULTS

In 613 respondents, mean age was 78 years, 78% were female, 11% had concomitant fibromyalgia, and 26% had 3+ comorbid conditions. Responses indicated moderate OA severity. Seventy percent reported poor sleep; 25% met criteria for RLS and 6.5% reported a diagnosed sleep disorder. Independent correlates of poor sleep were: greater arthritis severity (adjusted odds ratio (OR) per unit increase in WOMAC score=1.03, P<0.0001), 3+ comorbid conditions (adjusted OR=1.88; P=0.03), depressed mood (adjusted OR per unit increase in CES-D score=1.09, P<0.0001), and RLS (adjusted OR=1.87; P=0.02). Controlling for previously reported fatigue correlates, poor sleep was significantly associated with greater fatigue (parameter estimate=1.63, P=0.0003) and napping did not moderate this relationship (P=0.55 for the interaction between napping and poor sleep).

CONCLUSIONS

Among older people with OA, poor sleep is highly prevalent and significantly linked with fatigue. Identifying the nature of sleep disturbances in OA is important as treatment of sleep disturbances may reduce OA-related fatigue.

Fibromyalgia and fatigue: central processing, widespread dysfunction

Biological and psychological bases for the covariation of pain and fatigue in fibromyalgia (FM) are reviewed. FM is characterized as a disorder of central sensitization, with pain and fatigue as the most prominent symptoms. The roles of sleep disturbance and affective dysregulation as both precipitants and consequences of pain and fatigue in FM are discussed. It is argued that a positive affective disturbance may uniquely characterize pain and fatigue symptoms in FM. Finally, pharmacological and nonpharmacological treatments for FM are highlighted, with an emphasis on the efficacy of these treatments in alleviating pain and fatigue symptoms.

Psychiatric aspects of chronic fatigue syndrome and fibromyalgia

Chronic fatigue syndrome and/or fibromyalgia (CFS/FM) consists of highly overlapping, medically unexplained symptoms, including long-lasting fatigue, effort intolerance, cognitive dysfunction, and widespread pain and tenderness. CFS/FM often seems to be triggered by infections and physical trauma, but depression, sleep disturbances, and personality may also be involved. Moreover, dysregulation of the stress system, the immune system, and central pain mechanisms may determine the pathophysiology of the illness, leading to a loss of capacity to adapt to all kind of stressors. CFS/FM patients can be best helped by a pragmatic and individualized approach aimed at adjusting lifestyle and optimizing self-care, which in the long run may contribute to a restoration of physical and mental adaptability. Future psychiatric research into CFS/FM should focus on the complex interrelationships among pain/fatigue, stress/depression, and personality, as well as on processes of therapeutic change and the advantages of customized treatment.

Sex differences in the relations of positive and negative daily events and fatigue in adults with rheumatoid arthritis

Fatigue is a common, disabling symptom for individuals with rheumatoid arthritis (RA). This study 1) examined sex differences in the relations between daily changes in positive and negative interpersonal events and same-day and next-day fatigue and 2) tested positive affect and negative affect as mediators of the associations between changes in interpersonal events and fatigue. Reports of fatigue, number of positive and negative interpersonal events, and positive and negative affect were assessed daily for 30 days via diaries in 228 men and women diagnosed with RA. Days of higher than average daily positive events were associated with both decreased same-day fatigue and increased next-day fatigue, but only among women. Sex differences in same-day relations between positive events and fatigue were mediated by increases in positive affect. For both sexes, days of higher than average daily negative events related to increased same-day and next-day fatigue, and the same-day relations between negative events and fatigue were mediated by increases in negative affect. A more nuanced understanding of similarities and differences between men and women in the associations between changes in interpersonal events and fatigue may inform future interventions for RA fatigue.

PERSPECTIVE

This article presents an examination of sex differences in the links between changes in daily interpersonal events and fatigue in chronic pain patients. The findings can help clinicians target the psychosocial factors that potentially can ameliorate their patients' experience of fatigue.

Psychosocial factors and the pain experience of osteoarthritis patients: new findings and new directions

PURPOSE OF REVIEW

The present paper reviews recent psychosocial research in the area of osteoarthritis pain. First, the review highlights studies of psychosocial factors that can influence osteoarthritis pain. Next, research testing the efficacy of psychosocial treatments for osteoarthritis pain is summarized.

RECENT FINDINGS

Recent studies suggest that asking osteoarthritis patients to recall pain experiences may not be as accurate as having them keep daily pain records. New studies also support the notion that fatigue and increased weight are linked to higher osteoarthritis pain. Osteoarthritis patients who report higher levels of depression are more prone to report increased osteoarthritis pain. New studies also indicate that social factors such as ethnic background, ability to communicate pain to others, and participation in social activities can influence osteoarthritis pain and disability. Cognitions about pain (i.e. pain catastrophizing, acceptance, self-efficacy for pain) also have been found to relate to pain in patients with osteoarthritis. Recent, randomized controlled studies suggest that psychosocial interventions (i.e. self-management programs, exercise) can decrease osteoarthritis pain and disability.

SUMMARY

Several psychosocial variables have been suggested as influencing osteoarthritis pain and disability. There is evidence that psychosocial interventions may decrease osteoarthritis pain and disability.

Fatiguing exercise enhances hyperalgesia to muscle inflammation

Since many people with chronic fatigue present with pain and many people with chronic pain present with fatigue, we tested if fatigue would enhance the response to pain in male and female mice. We further tested for the activation of brainstem nuclei by the fatigue task using c-fos as a marker. Fatigue was induced by having mice spontaneously run in running wheel for 2h. Carrageenan (0.03%) was injected into the gastrocnemius muscle either 2h before or 2h after the fatigue task. The mechanical sensitivity of the paw (von Frey filaments), muscle (tweezers), grip force and running wheel activity was assessed before and 24h after injection of carrageenan. Both male and female mice that performed the fatigue task, either before or after intramuscular injection of carrageenan, showed an enhanced mechanical sensitivity of the paw, but not the muscle. Ovariectomized mice showed a similar response to male mice. There was a decrease in running wheel activity after carrageenan injection, but no change in grip force suggesting that mice had no deficit in motor performance induced by the carrageenan. C-fos expression was observed in the nucleus raphe pallidus, obscurus, and magnus after the fatigue task suggesting an increased activity in the raphe nuclei in response to the fatigue task. Therefore, widespread hyperalgesia is enhanced by the fatigue response but not hyperalgesia at the site of insult. We suggest that this effect is sex-dependent and involves mechanisms in the brainstem to result in an enhanced hyperalgesia.

Daily affect relations in fibromyalgia patients reveal positive affective disturbance

OBJECTIVES

To examine daily positive affective disturbance in the context of negative affect (NA) and pain among patients with fibromyalgia (FM) to determine a) if FM patients experience a deficit in daily positive affect (PA) relative to osteoarthritis (OA) patients; b) if FM patients differ from OA patients in the day-to-day relations of PA and NA; and c) if patients diagnosed with both OA and FM differ from patients with either OA-only or FM-only with respect to major outcomes.

METHODS

A total of 260 women with physician-diagnosed OA (n = 106), FM (n = 53), or OA/FM (n = 101) completed a 30-day electronic diary. Participants were assessed once daily on levels of PA, NA, and pain.

RESULTS

Multilevel models indicated that FM patients had less overall PA than OA patients and exhibited a stronger inverse PA-NA relation. Analyses further suggest that the OA/FM group may have been the most impaired of the three included in our study. This group was responsible for a lagged effect of PA on both affects, whereby high PA days resulted in low next-day PA and high next-day NA.

CONCLUSION

FM patients exhibit a PA disturbance compared with OA patients. This disturbance is reflected by an overall deficit in PA and an inability to sustain PA in the face of pain and NA. Patients with both OA and FM may represent a subgroup of FM that is at particular risk for dysregulation of PA.