Regulating Mood to Lessen Pain
Arthritis is painful. Being in pain can affect your emotional outlook. Likewise, your emotions can affect your pain. When your knees hurt a lot, you feel cranky and agitated – this is not a new concept. When you’ve had a bad day at work, your fingers feel especially sore and stiff. Understanding the way our emotions and pain processes interact is an active field of study.
What Problem Was Studied?
The way people regulate their affect – meaning how they control the experience of or expression of emotion – has frequently been observed to be a trait that is constant over time. To put it simply, either you’re a hot-head or you’re not. However, studies have shown that a person’s ability to regulate his emotions can wax and wane over hours or days. Whether rheumatoid arthritis pain is influenced by changes in your ability to control your emotions was the topic of a study conducted by a multicenter team of scientists, including Arthritis Foundation grant recipients Francis J. Keefe, PhD, and Mark A. Lumley, PhD.
What Was Done In the Study?
In total, 94 people with RA participated in the study. These people completed a diary at the end of each day in which they measured positive affect (good feelings) and negative affect (bad feelings) using the Positive and Negative Affect Schedule (PANAS). Each person indicated to what extent they experienced 20 different feelings each day. In addition, participants scored their daily pain on a visual analog scale. To complete the data gathering, participants indicated their age, sex and education level and a rheumatologist recorded their disease severity variables during an examination.
The researchers took these daily diaries and analyzed how the regulation of affect influenced pain. For example, if a person had more negative emotions than usual for them on day 9, did those feelings remain on day 10 or did they return toward normal (or better) on day 10? Did that regulation toward the person’s average result in less pain?
What Were the Study Results?
After extensive statistical analyses controlling for demographic and disease variables, the researchers were able to determine that recovering toward average (or better) from a bad mood corresponded with a lessening of pain. Likewise, participants who were filled with good feelings on day 9, for example, and maintained that good mood on day 10 had lower levels of pain on day 10.
The team also found that erythrocyte sedimentation rate (a measure of inflammation), joint count (number of tender or swollen joints) and age all had significant influences on the extent to which the regulation of affect influenced pain. Affect regulation was found to have a greater impact on pain intensity for individuals who were younger and for those with higher disease activity.
What Does This Mean For People With RA?
This study suggests that pain from RA may be lessened by moderating your expression of emotion and mood from one day to the next. Lead investigator Mark Connelly, PhD, proposes that although all people start with a usual level of positive and negative affect (either you generally are a sunshine and rose-petal person or a doom-and-gloom person), each individual’s pain experience may be impacted by learning certain skills. One such set of skills is called response-focused affect regulation, which refers to learning how to bring one’s mood back to desirable levels following inevitable “bad days.” Another set of skills comprises antecedent-focused affect regulation, which refers to the ability to prevent unusually negative days. Although everyone has natural skills for regulating emotions, additional training and refining can be achieved through consultation with psychologists or other allied health professionals.
Connelly M, Keefe FJ, Affleck G, Lumley MA, Anderson T, Waters S. Effects of day-to-day affect regulation on the pain experience of patients with rheumatoid arthritis. Pain 2007; in press. DOI: 10.1016/j.pain.2007.01.002
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