Stress-Related Clinical Pain and Mood in Women with Chronic Pain: Moderating Effects of Depression and Positive Mood Ind
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ORIGINAL ARTICLE
Stress-Related Clinical Pain and Mood in Women with Chronic Pain: Moderating Effects of Depression and Positive Mood Induction Mary C. Davis, Ph.D. & Kirti Thummala, B.A. & Alex J. Zautra, Ph.D.
# The Society of Behavioral Medicine 2013
Abstract Background Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain. Purpose This study aims to compare depressed and nondepressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery. Methods Women with fibromyalgia and/or osteoarthritis (N=110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological StudiesDepression scale, to positive versus neutral mood induction. Results Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression × mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions. Conclusions Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions. Keywords Chronic pain . Depression . Positive mood induction . Stress recovery
Depression is common among individuals with a chronic pain condition. Prevalence estimates suggest that roughly 18 % of pain patients in population-based settings and 27 % of pain patients in primary care clinics meet criteria for depression [1]. M. C. Davis (*) : K. Thummala : A. J. Zautra Department of Psychology, Arizona State University, P.O. Box 1104, Tempe, AZ 85287-1104, USA e-mail: [email protected]
The impact of comorbid depression on the health and quality of life of individuals in chronic pain can be substantial; across a range of chronic pain conditions, depressed patients report higher levels of pain and disability [2], display more pain behaviors [3], and respond more poorly to treatments [2] than their non-depressed counterparts. How might depression contribute to poorer adaptation in chronic pain? One possibility is via its impact on responses to stress. Among chronic pain patients, stress and other negative affective experiences are associated with increases in pain [4–6], an association that is especially strong among those with comorbid depressive symptoms [7]. This vulnerability of patients who are depressed may be due in part to their more frequent use of maladaptive emotion regulation strategies to manage stress compared to their non-depressed counterparts. In particular, depressed individuals have difficulty disengaging their attention from aversive stimuli; rather, they engage in prolonged processing of the information and elaboration about the negative experience [8, 9], which in turn propagates depressive affect. T
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