title: Painful effects of auditory startle, forehead cooling and psychological stress in patients with fibromyalgia or rheumatoid arthritis.
abstract: OBJECTIVE
  The aim of this study was to determine whether the clinical pain associated with rheumatoid arthritis or fibromyalgia would increase during standard laboratory tasks and, if so, whether these increases were linked with individual differences in psychological distress.
  
  
  METHODS
  Twenty-three patients with fibromyalgia and 16 patients with rheumatoid arthritis rated changes in clinical pain after an acoustic startle stimulus, during painful forehead cooling, and during stressful mental arithmetic. In addition, pain tolerance was assessed during a submaximal effort tourniquet test, and patients provided ratings of distress on a standard Depression, Anxiety and Stress Inventory.
  
  
  RESULTS
  Pain at rest was associated with depression scores in patients with rheumatoid arthritis, and was associated with stress scores in the fibromyalgia group. However, pain tolerance was unrelated to individual differences in psychological distress in either group. In patients with fibromyalgia, clinical pain increased after the acoustic startle stimulus and painful forehead cooling, and increased during stressful mental arithmetic. Arthritic pain also increased during forehead cooling and mental arithmetic in association with indices of psychological distress.
  
  
  CONCLUSIONS
  These findings suggest that processes linked with individual differences in distress aggravate pain in rheumatoid arthritis, whereas some other mechanism (e.g., failure of stress-related pain modulation processes or an aberrant interaction between nociceptive afferent and sympathetic efferent fibers) triggers stress-induced pain in fibromyalgia.
authors.affiliation: School of Psychology and Exercise Science, Center for Research on Chronic Pain and Inflammatory Disease, Murdoch University, Perth, Western Australia, Australia. p.drummond@murdoch.edu.au
authors.forename: Peter D
authors.initials: PD
authors.lastname: Drummond
authors.forename: Margot
authors.initials: M
authors.lastname: Willox
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000523:psychology*; D003080:Cold Temperature; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000523:psychology*; D005546:Forehead; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000523:psychology*; D010555:Personality Inventory; D013216:Reflex, Startle; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D055815:Young Adult