Stony Brook Researchers Identify Significant Fluctuations in Pain among Patients with Rheumatic Disease

A study by Stony Brook Clinical Instructor of Psychiatry Stefan Schneider, PhD, Associate Professor Dr. Joan E. Broderick, PhD, and others found significant day-to-day fluctuations in levels of pain, fatigue and other patient-reported outcomes among patients with rheumatic disease and identified depression and coping skills as factors that predict variability. Their findings were published online in the February 18 issue of Pain.

While most studies report pain in terms of average symptom levels, Drs. Schneider, Broderick, and colleagues explored how the experience of pain and other patient-reported outcomes varied from day to day within individual patients, and they identified some of the psychological factors that account for the variability. The outcomes they analyzed included self-reported pain, fatigue, happiness and frustration. Among the factors that might explain variability in these outcomes, they considered depression, anxiety and coping skills. They hypothesized that patients with greater psychological distress (depression and anxiety) and poorer coping strategies would show greater day-to-day variability in pain, fatigue and adjustment.

Using electronic diaries to capture daily fluctuations in symptoms, the researchers were able to take a finer-grained look at how patients with rheumatic diseases experience their symptoms. Drawing on data from two studies conducted by researchers at Stony Brook and other sites, Drs. Schneider, Broderick, and colleagues used a multilevel model for heterogeneous variances to analyze variances within individuals as well as between individuals. They also controlled for differences between weekday and weekend patient reports.

They were able to detect that some patients experience significantly more day-to-day fluctuations in symptoms than others, which provided a basis for studying predictors. Their analysis showed that measures of depression and coping skills significantly predicted daily fluctuations in symptoms, while anxiety scores did not.

The authors conclude that because fluctuations in pain and other patient-reported outcomes are a common experience for patients, even for those with stable disease such as osteoarthritis, clinicians should pay closer attention to how their patients’ pain varies and how this variability affects their lives. The finding that depression plays a role in pain variability suggests that treating an underlying depression may reduce variability of symptoms, enabling patients to manage their symptoms more effectively.

Drs. Doerte U. Junghaenel, Joseph E. Schwartz, and Arthur A. Stone from the Department of Psychiatry and Behavioral Science at Stony Brook University and Dr. Francis J. Keefe from Duke University were co-authors of the report. Pain is the official journal of the International Association for the Study of Pain. The research was supported by grants from the National Institutes of Health and the National Center for Research Resources.