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- All Subjects: Chronic Pain
- Creators: Davis, Mary C.
Description
Despite the strong link between pain and depressive symptoms, the mechanisms by which they are connected in the everyday lives of individuals with chronic pain are not well understood. In addition, previous investigations have tended to ignore biopsychosocial individual difference factors, assuming that all individuals respond to pain-related experiences and affect in the same manner. The present study tried to address these gaps in the existing literature. Two hundred twenty individuals with Fibromyalgia completed daily diaries during the morning, afternoon, and evening for 21 days. Findings were generally consistent with the hypotheses. Multilevel structural equation modeling revealed that morning pain and positive and negative affect are uniquely associated with morning negative pain appraisal, which in turn, is positively related to pain’s activity interference in the afternoon. Pain’s activity interference was the strongest predictor of evening depressive symptoms. Latent profile analysis using biopsychosocial measures identified three theoretically and clinically important subgroups (i.e., Low Functioning, Normative, and High Functioning groups). Although the daily pain-depressive symptoms link was not significantly moderated by these subgroups, individuals in the High Functioning group reported the lowest levels of average morning pain, negative affect, negative pain appraisal, afternoon pain’s activity interference, and evening depressive symptoms, and the highest levels of average morning positive affect across 21 days relative to the other two groups. The Normative group fared better on all measures than did the Low Functioning group. The findings of the present study suggest the importance of promoting morning positive affect and decreasing negative affect in disconnecting the within-day pain-depressive symptoms link, as well as the potential value of tailoring chronic pain interventions to those individuals who are in the greatest need.
ContributorsMun, Chung Jung (Author) / Karoly, Paul (Thesis advisor) / Davis, Mary C. (Thesis advisor) / Suk, Hye Won (Committee member) / Dishion, Thomas J (Committee member) / Arizona State University (Publisher)
Created2017
Description
Prevailing models describing coping with chronic pain posit that it is a complex day-to-day process that can involve psychosocial factors, including cognitive appraisals about pain, interpersonal challenges such as distressed social relationships, and reduced engagement in enjoyable experiences. Few studies, however, have applied a process-oriented approach to elaborate the relations between key pain-related appraisals, social environmental factors, and self-efficacy, a key self-appraisal for successful adaptation to chronic pain. This study used within-day daily diary methodology to test the following hypotheses: (a) increases in morning pain catastrophizing predict decreases in end of day pain self-efficacy; (b) increases in perceived stressfulness of interpersonal relations occurring during the day exacerbate the negative effects of morning catastrophizing on end-of-day pain self-efficacy; and (c) increases in perceived enjoyment of interpersonal relations occurring during the day mitigate the negative effects of morning pain catastrophizing on end of day pain self-efficacy. Within-day measures, including morning pain catastrophizing, afternoon interpersonal stress and enjoyment ratings, and end-of-day pain self-efficacy, were collected for 21 days via an automated phone system from 223 participants with widespread chronic pain. The use of diary data allowed for examination of time-varying processes related to pain adaptation. Results of multilevel regression models indicated that, consistent with prediction, increases in morning pain catastrophizing and predicted decreases in end-of-day pain self-efficacy. Contrary to prediction, changes in midday interpersonal enjoyment and stress did not moderate the within-day catastrophizing-efficacy relation. Rather increases in midday enjoyment and stable individual differences in enjoyment predicted end-of-day efficacy. Overall, findings suggest a within-day relation between pain cognition and social context and subsequent self-efficacy, and highlight potential targets for intervention in chronic pain.
ContributorsThummala, Kirti (Author) / Davis, Mary C. (Thesis advisor) / Zautra, Alex (Committee member) / Okun, Morris (Committee member) / Arizona State University (Publisher)
Created2018
Description
Current models of pain coping typically focus on how pain contributes to poor physical and psychological functioning. Researchers have argued that this focus on the negative consequences is too narrow and does not account for times when individuals are able to maintain meaningful functioning despite their pain. Thus, the current study sought to investigate the day-to-day processes that both help and hinder recovery from pain and persistence towards daily goals. Specifically, the present study tested: a) a two-factor model of risk and resilience “factors” that capture key processes across affective, cognitive and social dimensions of functioning, and b) whether the relation between morning pain and end-of-day physical disability is mediated by increases in these afternoon risk and resilience factors. Within-day study measures were collected for 21 days via an automated phone system from 220 participants with Fibromyalgia. The results of multi-level confirmatory factor analysis indicated that, consistent with prediction, risk and resilience do constitute two factors. Findings from multilevel structural equation models also showed resilience factor mediated the link between late morning increases in pain and end-of-day disability, in line with hypotheses. Although the vulnerability factor as a whole did not mediate the within-day link between pain and disability, pain-catastrophizing individually did serve as a significant mediator of this relation. This study was the first to empirically test a within-day latent factor model of resilience and vulnerability and the first to capture the multidimensional nature of the pain experience by examining mechanisms across affective, cognitive and social domains of functioning. The findings of the current study suggest that in addition to studying the processes by which pain has a negative influence on the lives of pain sufferers, our understanding of the pain adaptation process can be further improved by concurrently examining mechanisms that motivate individuals to overcome the urge to avoid pain and to function meaningfully despite it.
ContributorsThummala, Kirti (Author) / Davis, Mary C. (Thesis advisor) / Doane, Leah (Committee member) / Karoly, Paul (Committee member) / Barrera, Manuel (Committee member) / Arizona State University (Publisher)
Created2018
Description
Objective: The present study sought to 1) examine the measurement of emotional complexity (EC) by examining the associations among different indicators of EC (i.e., covariation between positive affect and negative affect; overall, negative, and positive granularity; overall, negative, and positive differentiation) derived from the same data set and identifying a latent factor structure; and 2) evaluate the predictive ability of EC on psychological distress, emotional well-being, and physical functioning while accounting for stressful contexts. The utility of assessing emotion diversity (ED) as another aspect of EC was also explored.
Methods: 191 middle-aged adults from a community-based study on resilience were asked to complete 30 daily diaries assessing positive and negative affect. At least 6 months later, participants completed a phone interview that assessed distress (i.e., depressive and anxiety symptoms), well-being (i.e., WHO-5 well-being, vitality, social functioning), physical functioning, and perceived stress.
Results: A three-factor solution with latent factors representing overall, negative, and positive EC was identified. Overall EC significantly predicted enhanced physical functioning, but was not associated with distress or well-being. Contrary to study hypotheses, positive and negative EC were not associated with future distress, well-being, or physical functioning, though a trend toward improved physical functioning was noted for positive EC. In contrast, positive and negative ED were both associated with less distress, and better well-being and physical functioning. Overall ED was unexpectedly related to worse outcomes (i.e., more distress, less well-being, decreased physical functioning). Stress did not moderate the relationship between emotional complexity and the outcome variables.
Conclusions: Different indicators of EC represent distinct aspects of emotional experience. Partial support of the hypotheses found. Physical functioning was the only outcome influenced by EC. The inclusion of stress did not change the results. The discrepancy between the findings and those in the literature may be related to reliability of EC indicators and absence of contextual factors. Further exploration of ED revealed a potentially important construct of emotional experience that is deserving of further inquiry.
Methods: 191 middle-aged adults from a community-based study on resilience were asked to complete 30 daily diaries assessing positive and negative affect. At least 6 months later, participants completed a phone interview that assessed distress (i.e., depressive and anxiety symptoms), well-being (i.e., WHO-5 well-being, vitality, social functioning), physical functioning, and perceived stress.
Results: A three-factor solution with latent factors representing overall, negative, and positive EC was identified. Overall EC significantly predicted enhanced physical functioning, but was not associated with distress or well-being. Contrary to study hypotheses, positive and negative EC were not associated with future distress, well-being, or physical functioning, though a trend toward improved physical functioning was noted for positive EC. In contrast, positive and negative ED were both associated with less distress, and better well-being and physical functioning. Overall ED was unexpectedly related to worse outcomes (i.e., more distress, less well-being, decreased physical functioning). Stress did not moderate the relationship between emotional complexity and the outcome variables.
Conclusions: Different indicators of EC represent distinct aspects of emotional experience. Partial support of the hypotheses found. Physical functioning was the only outcome influenced by EC. The inclusion of stress did not change the results. The discrepancy between the findings and those in the literature may be related to reliability of EC indicators and absence of contextual factors. Further exploration of ED revealed a potentially important construct of emotional experience that is deserving of further inquiry.
ContributorsArewasikporn, Anne (Author) / Zautra, Alex J (Thesis advisor) / Davis, Mary C. (Committee member) / Doane, Leah D (Committee member) / Infurna, Frank J. (Committee member) / Arizona State University (Publisher)
Created2016
Description
Comorbid posttraumatic stress disorder (PTSD) and chronic pain create a heavier symptom burden than does chronic pain alone. Individuals with both conditions may exhibit physiological and emotional reactivity that make them susceptible to distressing reactions to negative social-emotional stimuli as well as less able to capitalize on positive social-emotional experiences. The current study examined physiological and emotional reactivity to affective stimuli in a laboratory setting as well as social responses to changes in interpersonal events in daily life among individuals with fibromyalgia (FM) and a history of PTSD symptoms versus those with FM only. The impact of the type of traumatic event experienced was also examined. Participants’ startle reflex responses and emotional reactions to affective stimuli in a laboratory setting and social stress and enjoyment responses to interpersonal events in daily diaries were collected. Results indicated that higher levels of past PTSD symptoms were associated with higher levels of bodily pain, social stress, depression, negative affect, and less positive affect. Higher levels of past PTSD symptoms did not affect physiological or social-emotional reactivity to stimuli either in the laboratory setting or in the daily diaries. Individuals with a history of PTSD symptoms from sexual trauma exhibited lower startle magnitudes to positive emotional stimuli in the laboratory compared to individuals with no trauma or a history of PTSD symptoms from of other types of trauma. There were no differences among trauma types in responsivity to negative stimuli in the laboratory or social-emotional responses in daily life. Findings suggest lasting and stable effects of past PTSD symptoms on physical and emotional health in chronic pain, rather than reactivity to positive and negative changes in the environment. Findings indicate the need to assess for past trauma in pain patients and tailor treatments to account for specific traumas.
ContributorsWolf, Laurie (Author) / Davis, Mary C. (Thesis advisor) / Arizona State University (Publisher)
Created2016
Description
Socioeconomic status (SES) is linked with poorer health outcomes across the range of SES. The Reserve Capacity Model (RCM) proposes that low SES fuels repeated and/or chronic exposure to elevated levels of stress, producing deleterious emotional, psychological, social, and physiological changes that result in development of disease over time. The RCM further asserts that a relative lack of social and psychological resources, including efficacy and social support, among low SES individuals accounts for their greater vulnerability to the effects of stress. Although the links between stress, reserve capacity, and health outcomes are framed in the RCM as an ongoing process that produces disease, the majority of investigations testing the model have not examined its utility in explaining 1) coping with daily stressors or 2) symptom flares among individuals managing a chronic illness. This study investigated the effects of SES, reflected in income level, on the: 1) levels of daily financial events and financial worry; 2) relations between daily financial worry and symptoms of pain and fatigue; and 3) extent to which daily coping efficacy and social support mediated the daily financial worry-symptom relation across 21 daily diary reports collected from 220 individuals with fibromyalgia (FM). Simple correlations showed that income was inversely related to frequency of financial events and level of financial worry across 21 days. Results from multilevel models indicated that daily increases in financial worry were unrelated to pain regardless of income level, but were related to increased fatigue among individuals with lower relative to higher income. Daily efficacy and support mediated the relations between financial worry and pain and fatigue, but the extent of mediation did not differ based on high versus low income level. Taken together, the findings suggest that individuals of low versus high income encounter more frequent financial stress and experience greater daily fatigue exacerbation related to that stress, in line with the RCM. Over time, the greater exposure and reactivity to financial strain may account for the inverse relation between income and disability among those with chronic pain.
ContributorsMoore, Shannon Victoria (Author) / Davis, Mary C. (Thesis advisor) / Luecken, Linda J. (Committee member) / Suk, Hye Won (Committee member) / Arizona State University (Publisher)
Created2017
Description
An abundance of data has established the links between both pain-related cognitions and relationship attachment qualities in the experience of pain, including long-term functional health in chronic pain patients. However, relatively few studies have explored the dynamic relation between pain and pain-related cognitions within a day, and no studies have tested the moderating role of relationship attachment on the within-day cognition—pain association in chronic pain patients. The objectives of this study were to: 1) assess whether late morning pain flares predicted changes in afternoon positive and negative pain-related cognitive appraisals, and whether these changes in turn predicted end-of-day pain, and 2) explore whether adult attachment anxiety moderated the pain-cognition relation in individuals with chronic pain due to fibromyalgia. One hundred and seventy four partnered individuals with fibromyalgia completed initial assessments of demographics and attachment anxiety, and subsequently completed electronic assessments of pain intensity and positive and negative cognitive pain-related appraisals three times a day for three weeks. Multilevel structural equation modeling established that a latent negative cognitive appraisal factor (encompassing shared variance from catastrophizing, pain irritation, and self-criticism related to pain) mediated the link between late morning and end-of-day pain intensity, in line with the hypothesis. Analyses also provided some support for a mediating role for a positive cognitive appraisal factor (a composite of pain control, pain self-efficacy, and feeling pain without reacting) in the daily course of pain; the mediated effect for positive appraisals was weaker than the mediated effect of negative appraisals, but was sustained in a model that included negative appraisals. Inconsistent with prediction, attachment anxiety did not moderate the within-day links between pain and cognitions. These findings establish the dynamic links within day between pain and pain-related cognitions, and highlight the potential impact of both negative and positive cognitions on daily pain regulation. They point to the value of broadening cognitive-behavioral treatment strategies for chronic pain patients to target not only negative but also positive cognitions.
ContributorsTaylor, Shannon Stark (Author) / Davis, Mary C. (Thesis advisor) / Zautra, Alex (Committee member) / Okun, Morris (Committee member) / Doane, Leah (Committee member) / Arizona State University (Publisher)
Created2015