Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night’s sleep quality to next day reports of disability have not been examined. The current study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports, collected from 220 FM patients for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with Multilevel Structural Equation Modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain, and negative affect was not a significant mediator. In summary, the findings identify two parallel mechanisms, pain and positive affect, through which the prior night’s sleep quality predicts disability the next day in FM patients. Further, results highlight the potential utility of boosting positive affect following a poor night’s sleep as one means of preserving daily function in FM.

Even among patients with the same type and severity of headache, there is considerable variability in functional outcomes. Some individuals are resilient, able to thrive despite pain, whereas others find that pain is an overwhelming burden that comes to define their lives. A substantial body of evidence suggests that patients' cognitive, emotional, and behavioral coping responses to their pain play a significant role in determining their long-term health. Resilient pain responses, which are shaped by both qualities of the individual and his/her social environment, can be learned and thus hold promise as targets for treatment. We draw on recent empirical findings that identify which pain beliefs, appraisals, and behaviors in response to pain are key to resilient and non-resilient coping among patients with chronic headache. We discuss how pain self-efficacy and pain acceptance set the stage for adaptive behaviors that have been linked to sustained well-being and good quality of life. We then describe psychosocial and behavioral interventions that show promise in promoting resilience among headache patients and conclude by considering areas ripe for further inquiry.

Objective. Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self-efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1-year timeframe. Methods. Data from 462 participants (441 women) were analyzed using an autoregressive path analytical model with first-and second-order cross-lagged effects. Results. Self-efficacy was the only significant predictor of depression, physical functioning, and pain intensity ratings across time. Physical functioning at 6 months predicted self-efficacy at 1 year; no other factors related significantly to self-efficacy in the model. Conclusion. Our model suggests that self-efficacy is a salient factor in fibromyalgia symptomatology. Our findings support designing interventions that use a multimodal approach, with an explicit focus on combining exercise (or other means) to improve physical functioning and psychotherapy (e.g., cognitive-behavioral therapy) with the intention of reprocessing the functional improvements and the implications of these improvements for the patients' ability to manage their fibromyalgia symptoms. By doing so, self-efficacy should be enhanced, and this would produce the greatest and broadest benefits for fibromyalgia patients.

Women account for over 80 % of the fibromyalgia syndrome (FMS) population. Some researchers have noted that a large percentage of women with FMS have had hysterectomies. The purpose of this study was to examine the relationship between FMS and hysterectomies, and to examine the impact of having a hysterectomy on health status and health care costs. A sample of 573 American women, who were members of a health maintenance organization with a confirmed diagnosis of FMS, reported whether they had a hysterectomy. Participants completed the Quality of Well-Being Scale and their annual health care costs were calculated based on their medical records. Almost half of the sample (48.3 %) reported having had a hysterectomy, with 90.7 % reporting having had the surgery before their FMS diagnosis. Those who had a hysterectomy had significantly lower general health status and incurred higher health care costs than the women with FMS who did not have a hysterectomy. The percentage of women with FMS who had a hysterectomy was considerably higher than that found in the general population. In this study, having a hysterectomy and a diagnosis of FMS was related to poorer health status and higher health care costs.

Because pain is in part an affective experience, investigators over the past several decades have sought to elaborate the nature of pain-affect connections. Our evolving understanding of the intersection of pain and affect is especially relevant to intervention efforts designed to enhance the quality of life and functional health of individuals managing chronic pain. This chapter describes how pain influences arousal of the vigilance/defensive and appetitive/approach motivational systems and thus the affective health of chronic pain patients. The focus then moves to the dynamic relations between changes in pain and other stressors and changes in positive and negative affect as observed in daily life and laboratory-based experiments. A consensus emerges that sustaining positive affect during pain and stress flares may limit their detrimental effects and promote better functional health. The authors consider the implications of increased understanding of the dynamic interplay between pain and affective experience for enhancing existing interventions.

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Background and Purpose: The U.S. population is living longer; therefore, a relatively large proportion of the population is likely to experience chronic illnesses within their lifetime. An experimental study was conducted to examine factors influencing the likelihood of hiring a Health Care Advocate (HCA). Methods: Survey data were collected from a randomly selected community sample of participants (N = 470) over the age of 18 who were provided with a description of an HCA and a written vignette describing a medical scenario. Participants read one of eight vignettes in which they were asked to imagine they were in a car accident and required medical care. Age, injury (chronic vs. acute), and presence of comorbid chronic condition were manipulated. Results: A significant interaction indicated that when there was no pre-existing chronic health condition, sustaining a chronic injury increased the likelihood of hiring an HCA. In addition, younger adults with comorbid conditions were perceived as having greater need for an HCA than younger adults without comorbid conditions. Older adults were perceived as benefiting from HCAs regardless of comorbid conditions. Conclusion: This study demonstrates the need for patient-centered support for older adults following an injury, and for younger adults when a pre-existing chronic condition exists. Efforts should be made to target services to these populations of interest.

Purpose: To examine ethnic differences in ratings of 1) condition severity, 2) need for medical assistance, and 3) likelihood of hiring a Healthcare Advocate (HCA) for an ill, elderly parent as a function of 1) parent’s cognitive state (Alzheimer’s disease [AD] or cognitively healthy), 2) parent’s physical malady (hip fracture or heart attack), and 3) distance (near or far from the parent), with an emphasis on the interaction between ethnicity and cognitive state. Method: Nine-hundred-seventy-four individuals who identified as White, Black, Hispanic, or Asian/Pacific Islander read a hypothetical vignette about an older man. The man’s physical malady (heart attack or hip fracture), cognitive state (AD or no AD), and physical distance from a close family member were manipulated in the vignette. Participants rated the severity of the medical condition and their likelihood of hiring an HCA. Results: Black and Asian/Pacific Islander participants did not differ from White participants on any outcomes. Unlike White participants, Hispanic participants did not rate the older man’s condition as more severe and were not more likely to seek assistance when he had AD than when he was cognitively healthy. Conclusion: Ethnic differences in perceptions of AD may be less extensive than previously thought. The medical severity of AD did not appear to be recognized among the Hispanic participants in our sample, suggesting that culturallysensitive AD education may be particularly important in this subgroup.