Positive affect and pain

Abstract

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.

The association between pain and sleep in fibromyalgia

“…Moreover, negative effect has been associated with poor sleep in individuals with chronic pain 93-96. Consistent with the results of previous research, the current findings24,28,29,33 suggest that negative mood in FM patients could affect the association between pain and sleep disturbance, as a covariate. Considering that these patients generally experience greater stress relative to healthy individuals,97-99 it is not surprising that negative emotional functioning interacts with FM symptoms.…”

“…Nine studies (one high, 5 medium, and 3 low quality) found that sleep exerted a significant effect on pain in FM;20-24,26,27,29,33 however, one study of medium quality28 failed to demonstrate this effect. In contrast, 4 studies of medium quality21,30,31,35 showed that pain significantly influenced sleep.…”

Depressive Symptoms and Momentary Mood Predict Momentary Pain Among Rheumatoid Arthritis Patients

“…Further, positive mood was related to pain-related restrictions among those who were not depressed and to both pain and restrictions among those who were depressed; in contrast, negative mood was related to pain and pain-related restrictions only among those who were depressed. This finding is in concordance with results from several studies of daily positive mood and pain (e.g., 16, 17, 44) and a perspective that positive mood is associated with resilience to pain in RA (14). Finan and colleagues (17) found what they interpreted as a more robust effect of daily positive mood than daily negative mood: On days when participants had higher daily positive affect (than their individual average across days), they had significantly lower daily pain severity, even after controlling for the effect of daily negative affect, whereas the effect of daily negative affect did not hold after controlling for daily positive affect.…”

“…Finan and colleagues (17) found what they interpreted as a more robust effect of daily positive mood than daily negative mood: On days when participants had higher daily positive affect (than their individual average across days), they had significantly lower daily pain severity, even after controlling for the effect of daily negative affect, whereas the effect of daily negative affect did not hold after controlling for daily positive affect. Further, in a daily diary study of fibromyalgia patients, pain and positive affect, but not negative affect, mediated the relationship between sleep quality and activity interference (44). Additional research will be needed to determine whether and under what circumstances positive mood has a more consistent and/or stronger effect on momentary pain.…”

Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator?

“…For example, in a sample of adults with fibromyalgia, Kothari and colleagues 20 reported that PA (but not NA) mediated the relation between poor sleep quality and later activity interference. Although the present findings regarding PA are similar for functional disability, we additionally found NA was a significant mediator of the sleep-disability relationship.…”