Emotional Dynamics in Fibromyalgia: Pain, Fatigue, and Stress Moderate Momentary Associations Between Positive and Negative Emotions.

Affective disruptions, particularly deficits in positive affect, are characteristic of fibromyalgia (FM). The Dynamic Model of Affect provides some explanations of affective disruptions in FM, suggesting that the inverse association between positive and negative emotions is stronger when individuals with FM are under greater stress than usual. However, our understanding of the types of stressors and negative emotions that contribute to these affective dynamics is limited. Using ecological momentary assessment (EMA) methods, 50 adults who met the FM survey diagnostic criteria rated their momentary pain, stress, fatigue, negative emotions (depression, anger, and anxiety), and positive emotions 5X/day for eight days using a smartphone application. Results of multilevel modeling indicate that, consistent with the Dynamic Model of Affect, there was a stronger inverse association between positive emotion and negative emotions during times of greater pain, stress, and fatigue. Importantly, this pattern was specific to depression and anger, and was not present for anxiety. These findings suggest that fluctuations in fatigue and stress may be just as important or more important than fluctuations in pain when understanding the emotional dynamics in FM. In addition, having a more nuanced understanding of the role that different negative emotions play may be similarly important to understanding emotional dynamics in FM. PERSPECTIVE: This article presents new findings on the emotional dynamics in FM during times of increased pain, fatigue, and stress. Findings highlight the need for clinicians to conduct a comprehensive evaluation of fatigue, stress, and anger in addition to more routinely assessed depression and pain when working with individuals with FM.

Active or passive pain coping: Which predicts daily physical and psychosocial functioning in people with chronic pain and spinal cord injury?

PURPOSE/OBJECTIVE: Despite medical and psychotherapeutic treatments, chronic pain is one of the most challenging and disabling conditions for individuals with spinal cord injury (SCI). A growing body of research has demonstrated that pain coping strategies are effective for the adjustment of pain. However, we still lack an understanding of how passive pain coping and active pain coping relate to daily physical and psychosocial functioning for people with chronic pain and SCI. The current study used end-of-day (EOD) diary data to examine associations of passive and active pain coping with same-day independence, positive affect and well-being, social participation, pain catastrophizing, depressive symptoms, and pain interference in adults with chronic pain and SCI. RESEARCH METHOD/DESIGN: This observational study in N = 124 individuals with SCI (mean age = 47.53 years; 74.2% male, 25.8% female) used a combination of baseline surveys and seven consecutive days of end-of-day (EOD) diaries. RESULTS: Results of multilevel modeling showed that, beyond the effects of key demographic variables, clinical variables (e.g., time since injury, mobility) and daily pain intensity, increased daily passive coping (from that person's average) related to increased same-day depressive symptoms (B = .29; p < .001), pain catastrophizing (B = .28; p < .001) and decreased same-day positive affect and well-being (B = -.31; p = .02). Increased daily active coping was related to higher same-day catastrophizing (B = .09; p < .05). CONCLUSIONS/IMPLICATIONS: Behavioral interventions for pain often emphasize adoption and practice of new active coping strategies. Findings highlight the potential importance of also addressing passive coping strategies in services of improvement in physical and psychosocial outcomes in individuals with chronic pain and SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Linguistic indicators of chronic pain acceptance in individuals with spinal cord injury.

OBJECTIVE: Pain acceptance is a robust predictor of adjustment to chronic pain, including pain in those with spinal cord injury (SCI). This preliminary study aimed to identify linguistic patterns indicative of chronic pain acceptance to gain new insights into the underlying cognitive-emotional process of this construct. METHOD: Individuals with SCI and chronic pain (N = 30) completed the Chronic Pain Acceptance Questionnaire (CPAQ) and a semistructured interview about their pain. Linguistic Inquiry and Word Count software was used to quantify linguistic categories of interest in transcribed interviews. RESULTS: Results of hierarchical linear regressions (controlling for pain intensity, age, and education) showed that personal pronouns explained an additional 26.9% of the variance in CPAQ activity engagement, which was associated with a lower frequency of first-person plural pronouns and a higher frequency of third person pronouns. Conjunction words explained an additional 12.8% and 19.2% of the variance in CPAQ total and pain willingness scores, respectively; frequency of conjunction words was negatively associated with acceptance. Perceptual processes words accounted for an additional 39.9% of the variance in pain willingness, which was associated with a lower frequency of seeing words and a higher frequency of hearing and feeling words. CONCLUSIONS: Findings suggest that pain acceptance is associated with unique linguistic patterns that can be identified in natural word use among individuals with SCI and chronic pain. Future research to further investigate linguistic indicators of pain acceptance and other clinically relevant pain constructs is warranted and could advance theoretical models of pain adaptation and clinical approaches to treating pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A review of the use and psychometric properties of the chronic pain acceptance questionnaires.

This review summarizes data presented in published psychometric papers evaluating the measurement properties of the Chronic Pain Acceptance Questionnaire (CPAQ) measures. The CPAQ measures quantify levels of acceptance of chronic pain across two facets of acceptance: willingness to experience rather than avoid or control pain and engagement in daily activities and life goals despite the presence of pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Role of Environmental Distractions in the Experience of Fibrofog in Real-World Settings.

OBJECTIVE: Perceived cognitive dysfunction in people with fibromyalgia (FM), "fibrofog," is commonly reported and has been demonstrated in neurocognitive testing. Distractibility and inattention have been implicated as potential contributors to fibrofog, but the role of environmental distractions has not been explored. In this study, ambulatory assessment methods were used to examine whether FM is related to more environmental distractions and to examine the impact of distractions on subjective and objective cognitive functioning. METHODS: Fifty people with FM and 50 age-, sex-, and education-matched controls without FM completed 8 consecutive days of ambulatory assessments. Five times per day, participants reported perceived cognitive functioning and environmental distractions and completed validated tests of processing speed and working memory. RESULTS: The FM group reported distractions in a higher proportion of the ambulatory cognitive testing sessions (40.5%) compared with the group without FM (29.8%; P < 0.001) and more often reported multiple simultaneous distractions. For both groups, sound was the most common distraction. The group with FM reported more distractions caused by light, and the group without FM reported more social distractions. Group differences in subjective and objective cognitive functioning were not augmented during distraction relative to during periods of no distraction. There were no group differences in within-person changes in cognitive functioning as a function of distraction. CONCLUSION: The group with FM reported more distractions than the group without FM; both groups reported poorer processing speed when distracted, and the effects of distraction on test performance did not differ significantly by group. Findings suggest that sensitivity to environmental distractions may play a role in the experience of cognitive dysfunction in FM.

Pain Acceptance in People With Chronic Pain and Spinal Cord Injury: Daily Fluctuation and Impacts on Physical and Psychosocial Functioning.

Daily fluctuation in pain acceptance and its impact on the physical and psychosocial functioning of individuals living with spinal cord injury (SCI) and chronic pain has not been examined. We used end-of-day diaries and multilevel modeling to examine the moderating effect of within- and between-person pain acceptance on associations between pain and physical and psychosocial functioning. Individuals with SCI and chronic pain (N = 124) completed 7 days of end-of-day diaries, which included measures of pain acceptance, pain intensity, pain catastrophizing, pain interference, participation in social roles and activities, depressive symptoms, and positive affect and well-being. We found within-person variability in pain acceptance (28% of the total variance) and a significant moderating effect of daily fluctuation in pain acceptance on the same-day pain intensity-social roles and activities association. Within-person changes in pain acceptance were also associated with daily changes in pain interference, depressive symptoms, and positive affect and well-being, adjusting for pain intensity and catastrophizing. Findings highlight the potential for daily or momentary assessments of pain acceptance to enhance understanding of how psychological flexibility may contribute to pain-related outcomes. Future studies could further investigate stable and variable characteristics of pain acceptance and their individual contribution to physical and psychosocial functioning. PERSPECTIVE: Daily fluctuations in pain acceptance and their association with physical and psychosocial functioning were observed in the lives of individuals with SCI and chronic pain. These findings may guide future studies to inform the development of effective, pain acceptance-focused individualized treatment approaches for chronic pain management in people with SCI.

Fibrofog in Daily Life: An Examination of Ambulatory Subjective and Objective Cognitive Function in Fibromyalgia.

OBJECTIVE: Perceived cognitive dysfunction in fibromyalgia (FM), "fibrofog," is common. Prior laboratory-based studies have limited our understanding of cognitive function in FM in daily life. The objective of this study was to explore levels of subjective and objective cognitive functioning and the association between subjective and objective aspects of cognition in people with and without FM in the lived environment. METHODS: Participants (n = 50 adults with FM; n = 50 adults without FM, matched for age, sex, and education) completed baseline measures of subjective and objective cognitive functioning (NIH Toolbox). They also completed ecological momentary assessments of cognitive clarity and speed and tests of processing speed and working memory, via a smart phone app, 5×/day for 8 days. RESULTS: On baseline objective measures, the FM group demonstrated poorer cognitive functioning across 3 NIH Toolbox tests. There were no strong correlations between subjective and objective cognitive functioning in both the FM and control groups. In the lived environment, the FM group demonstrated poorer subjective cognition and objective working memory; groups did not differ on processing speed. Momentary ratings of subjective cognitive dysfunction were significantly related to changes in objective processing speed but not working memory, with no group differences. CONCLUSION: Findings indicate worse laboratory-based and ambulatory subjective and objective cognitive function for those individuals with FM compared to those without FM. Similar associations between measures of subjective and objective cognitive functioning for the groups suggest that people with FM are not overstating cognitive difficulties. Future research examining contributors to ambulatory fibrofog is warranted.