Variability in negative emotions among individuals with chronic low back pain: relationships with pain and function

Abstract

Chronic pain is associated with elevated negative emotions, and resources needed to adaptively regulate these emotions can be depleted during prolonged pain. Studies of links between pain, function, and negative emotions in people with chronic pain, however, have focused almost exclusively on relationships among mean levels of these factors. Indexes that may reflect aspects of emotion regulation have typically not been analyzed. We propose that 1 index of emotion regulation is variability in emotion over time as opposed to average emotion over time. The sample was 105 people with chronic low back pain and 105 of their pain-free spouses. They completed electronic diary measures 5x/d for 14 consecutive days, producing 70 observations per person from which we derived estimates of within-subject variance in negative emotions. Location-scale models were used to simultaneously model predictors of both mean level and variance in patient negative emotions over time. Patients reported significantly more variability in negative emotions compared to their spouses. Patients who reported higher average levels of pain, pain interference, and downtime reported significantly higher levels of variability in negative emotions. Spouse-observed pain and pain behaviors were also associated with greater variability in patients' negative emotions. Test of the inverse associations between negative emotion level and variability in pain and function were significant but weaker in magnitude. These findings support the notion that chronic pain may erode negative emotion regulation resources, to the potential detriment of intra- and inter-personal function.

A Prospective Study of Dorsal Root Ganglion Stimulation for Non-Operated Discogenic Low Back Pain

“…Severe chronic pain may have sequelae such as the avoidance of physical activity and sleep loss. An unfortunate cascade can then develop, leading to deconditioning, disability, work absence (6), decreases in participation, mood changes, and overall lower quality of life (5,(7)(8)(9)(10).…”

Chronic pain in the workplace: A diary study of pain interference at work and worker strain

“…Perceptions of pain interference, then, represent secondary appraisal of stress, in that the individual perceives that his or her experiences of pain have interfered with their functioning at work. As such, it is not surprising that pain interference relates to negative affect (Gatchel, Peng, Peters, Fuchs, & Turk, ; Gerhart et al, ; Lazarus, ); we further propose that it predicts end‐of‐workday emotional exhaustion.…”

“…Specific emotions resulting from appraisals of harm, loss, and threat include (“anger, anxiety, fear, guilt, shame, sadness, envy, jealousy, and disgust” Lazarus, , p. 827). These emotions are commonly identified as describing negative affect (Busseri, ; Watson & Tellegen, ), which has long been associated with chronic pain (Gaskin, Greene, Robinson, & Geisser, ; Gerhart et al, ). Given our application of appraisal theory, we propose that pain interference, as a secondary appraisal, will positively relate to negative affect at work, while controlling for somatic pain experiences.Hypothesis Controlling for somatic pain experiences, pain interference at work positively relates to negative affect at work.…”

Action of ear acupuncture in people with chronic pain in the spinal column: a randomized clinical trial

“…These effects can be explained due to the possible psychological effects which may appear due to the volunteers’ expectations in relation to the therapy, which is termed the “placebo effect” 30 . Indeed, studies have indicated that pain influences many dimensions apart from the physical aspects, such as that the psychological factors 31 - 32 .…”