title: Individual differences in the day-to-day variability of pain, fatigue, and well-being in patients with rheumatic disease: associations with psychological variables.
abstract: This report examines day-to-day variability in rheumatology patients' ratings of pain and related quality-of-life variables as well as predictors of that variability. Data from 2 studies were used. The hypothesis was that greater psychological distress (i.e., depression and anxiety) and poorer coping appraisals (i.e., higher pain catastrophizing and lower self-efficacy) are associated with more variability. Electronic daily diary ratings were collected from 106 patients from a community rheumatology practice across 28 days (study 1) and from 194 osteoarthritis patients across 7 days (study 2). In multilevel modeling analyses, substantial day-to-day variability was evident for all variables in both studies, and individual patients differed considerably and somewhat reliably in the magnitude of their variability. Higher levels of depression significantly predicted greater variability in pain, as well as in happiness and frustration (study 1). Lower self-efficacy was associated with more variability in patients' daily satisfaction with accomplishments and in the quality of their day (study 2). Greater pain catastrophizing and higher depression predicted more variability in interference with social relationships (study 2). Anxiety was not significantly associated with day-to-day variability. The results of these studies suggest that individual differences in the magnitude of symptom fluctuation may play a vital role in understanding patients' adjustment to pain. Future research will be needed to examine the clinical utility of measuring variability in patients' pain and well-being, and to understand whether reducing variability may be an important treatment target.
authors.affiliation: Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneider
authors.forename: Doerte U
authors.initials: DU
authors.lastname: Junghaenel
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Stone
authors.forename: Joan E
authors.initials: JE
authors.lastname: Broderick
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002940:Circadian Rhythm / Q000502:physiology; D005221:Fatigue / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology; D012216:Rheumatic Diseases / Q000453:epidemiology / Q000523:psychology*; D013997:Time Factors