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Anger, Sadness Increase Pain in Women With Fibromyalgia

Negative emotions increase pain responses in women with and without fibromyalgia (FM), while combined treatment with cognitive behavioral therapy and a tailored exercise program can improve outcome in FM, according to two studies published in the October issue of Arthritis Care & Research.

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Henriët van Middendorp, Ph.D., of Utrecht University in the Netherlands, and colleagues conducted an experimental study of women with and without FM to examine the effects of emotions on pain response. The researchers found that sadness predicted clinical pain responses, and anger predicted both clinical and electrically-stimulated pain responses. Both women with and without FM reported increased pain in response to both of these emotions; more intense emotion was associated with a greater pain response.

Saskia van Koulil, of the Radboud University Nijmegen Medical Centre in the Netherlands, and colleagues classified patients with FM into two groups based on their clinical pattern — pain-avoidance or pain-persistence — and randomized them to either cognitive behavioral therapy and exercise training or to a wait list for the treatments. They found that use of this combined program at an early stage of FM (soon after diagnosis) was likely to promote improved treatment outcomes for high-risk patients with either pain-avoidance or pain-persistence patterns.

“Building on these findings, we can now report for the first time relatively large physical and psychological improvements in high-risk FM patients following a treatment specifically addressing pain-avoidance and pain-persistence patterns,” van Koulil and colleagues conclude. “However, as previous meta-analyses and recent studies of non-tailored interventions in chronic physical conditions have overall shown not more than moderate effects, the results of this study [suggest] that a tailored approach is promising for improving treatment effects.”

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