Mood and Pain are Intertwined in Rheumatoid Arthritis

September 22, 2015
Rita Baron-Faust MPH

Minor episodes of pain throughout the day can affect your mood and health outcomes.

A positive mood can lessen pain and reduce arthritis-related restrictions in rheumatoid arthritis, but then a negative mood can make things worse, research shows. A team at Penn State University enrolled 31 rheumatoid arthritis patients who were asked to record their symptoms on a mobile app five times a day for one week. They rated pain, swelling, stiffness and arthritis-related restrictions to daily routines and activities. They also recorded pain episodes and mood during the episodes.[[{"type":"media","view_mode":"media_crop","fid":"41582","attributes":{"alt":"©Lightpoet/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_265235956758","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4417","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]] "Although it’s fairly common for people in everyday life to report that negative moods can exacerbate physical pain, most evidence to support this association comes from cross-sectional, longitudinal studies over fairly lengthy periods, months or years, or from laboratory studies where mood and/or pain are manipulated, as opposed to occurring naturally,” writes lead author Jennifer E. Graham-Engeland, PhD, an associate professor of biobehavioral health at Penn State. While greater depressive symptomatology predicted more pain and arthritis-related restrictions, this effect was not accounted for by mood alone, the researchers wrote online in the Annals of Behavioral Medicine. The analysis, controlling for gender, age, weekend day, time of day and experiences of stress, also found that the effect of depressive symptoms was not due to differences in day-to-day mood.  “I do think that the connection between mood and pain in the moment (in daily life) is likely bi-directional,” Dr. Graham-Engleland told Rheumatology Network in an interview. “A momentary exacerbation in pain (such as pain from opening a jar or bending over to put on clothes) can trigger negative mood, whereas a sudden increase in negative mood (such as from feeling frustrated or getting bad news) can exacerbate feelings of pain.” Other observational studies have used end-of-day assessments for mood and pain. This was the first study to gather moment-to-moment data, which could have important implications for pain management strategies.  Questions remain about links between pain, depression, anxiety, stress and inflammatory cytokines and stress hormones -- and the directionality of those links.  

The Inflammation-Depression Link

 Depression is a frequent symptom in rheumatoid arthritis and other autoimmune diseases. As recently reported in

Rheumatology Network

, treating depression may also help control early polyarthritis, including pain. The inflammatory cytokine tumor necrosis factor-alpha (TNF-α) has also been found to be elevated in people with depression. And some research suggests that lowering inflammation with TNF-α inhibitors helps depressive symptoms in patients with psoriasis and Crohn’s disease, both of which are inflammatory diseases. The Penn State study indicates that since both depression and mood are uniquely associated with momentary pain. Multi-component interventions could improve pain and pain-related quality of life in rheumatoid arthritis and other diseases characterized by chronic pain, the researchers write.  “This and other research suggests that mood and depressive symptoms can be an important target for those with chronic pain conditions and that the improvement of mood and depressive symptomatology can give people more control over their pain and feel better in general,” Dr. Graham-Engeland said. 

References:

Graham-Engeland JE, Zawadzki MJ, Slavish DC, Smyth JM.

Depressive Symptoms and Momentary Mood Predict Momentary Pain Among Rheumatoid Arthritis Patients. Annals Behavioral Medicine.

Online First. August 14, 2015. DOI 10.1007/s12160-015-9723-2http://link.springer.com/article/10.1007/s12160-015-9723-2   Leblanc-Trudeau C, Dobkin P, Carrier N, et al.

Depressive symptoms 

predict future simple disease activity index scores and simple disease activity index remission in a prospective cohort of patients with early inflammatory polyarthritis.Rheumatology.

July 25, 2015. doi:10.1093/rheumatology/kev272  3-Raison CL, Rutherford RE, Woolwine BJ, et. al.,

A Randomized Controlled Trial of the Tumor Necrosis Factor Antagonist Infliximab for Treatment-Resistant Depression.JAMA Psychiatry

2013;70(1):31-41. Published online September 3, 2012. doi:10.1001/2013.jamapsychiatry.4