title: Predictive relationships between chronic pain and negative emotions: a 4-month daily process study using Therapeutic Interactive Voice Response (TIVR).
abstract: This article examines temporal relationships between negative emotions and pain in a cohort of 33 patients with chronic musculoskeletal pain enrolled in a telephone-based relapse prevention program (Therapeutic Interactive Voice Response [TIVR]), after 11 weeks of group cognitive behavioral therapy (CBT). Patients were asked to make daily reports to the TIVR system for 4 months after CBT. Patients' daily reports were analyzed with path analysis to examine temporal relationships between 3 emotion variables (anger, sadness, and stress) and 2 pain variables (pain and pain control). As expected, same-day correlations were significant between emotion variables and both pain and pain control. The lagged associations revealed unidirectional relationships between pain and next-day emotions: increased pain predicted higher reports of sadness the following day (P < .05). Conversely, increased pain control predicted decreased sadness and anger the following day (P < .05). Unlike some previous studies, this study did not reveal that an increase of negative emotions predicted increased next-day pain. We speculate that CBT treatment followed by the relapse prevention program teaches patients how to modulate negative emotions such that they no longer have a negative impact on next-day pain perception. The clinical implications of our findings are discussed.
authors.affiliation: Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT 05401, USA. magdalena.naylor@uvm.edu
authors.forename: Magdalena R
authors.initials: MR
authors.lastname: Naylor
authors.forename: G Michael
authors.initials: GM
authors.lastname: Krauthamer
authors.forename: Shelly
authors.initials: S
authors.lastname: Naud
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: John E
authors.initials: JE
authors.lastname: Helzer
mesh_terms: D000786:Anger; D059350:Chronic Pain / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology / Q000523:psychology; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013689:Telephone