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.
