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The Impact of Emotion-Related Autonomic Nervous System Responsiveness on Pain Sensitivity in Female Patients With Fibromyalgia

van Middendorp, Henriët PhD; Lumley, Mark A. PhD; Houtveen, Jan H. PhD; Jacobs, Johannes W.G. MD, PhD; Bijlsma, Johannes W.J. MD, PhD; Geenen, Rinie PhD

doi: 10.1097/PSY.0b013e3182a03973
Original Articles

Objective Patients with fibromyalgia have shown hyporeactive autonomic nervous system (ANS) responses to physical stressors, augmented pain to ANS changes, and heightened negative emotions, which can increase pain. This study examined ANS reactivity to negative emotions and its association with pain in fibromyalgia and control participants.

Methods Sixty-two women with fibromyalgia and 59 women in a control group recalled neutral, and anger- and sadness-eliciting experiences while ANS activity was monitored. Clinical and experimental pain were assessed in response to each emotion.

Results Compared with neutral recall, heart rate (p = .050), mean arterial pressure (p < .001), and high-frequency heart rate variability (p = .012) increased in response to sadness, whereas heart rate decreased (p = .002) and mean arterial pressure increased (p < .001) in response to anger; however, ANS responses did not differ between patients and control participants (all p > .29). Among patients only, decreased preejection period (anger-pain threshold: r = 0.31, p = .018) and total peripheral resistance in response to negative emotions (anger-pain tolerance: r = 0.35, p = .025; sadness-pain threshold: r = 0.51, p < .001; sadness-pain tolerance: r = 0.61, p < .001) correlated with more pain.

Conclusions These data suggest that the ANS is not hyporesponsive to elicited emotions in fibromyalgia; however, patients with a larger pain response showed an ANS response pattern reflecting heightened β-adrenergic and reduced α-adrenergic reactivity. Future research should test whether a specific ANS response pattern to emotions is a consequence of increased pain or whether it amplifies pain.

From the Department of Clinical and Health Psychology (H.v.M., J.H.H., R.G.), Utrecht University, the Netherlands; Department of Rheumatology and Clinical Immunology (H.v.M., J.W.G.J., J.W.J.B., R.G.), University Medical Center, Utrecht, the Netherlands; Department of Medical Psychology (H.v.M.), Radboud University Nijmegen Medical Center, the Netherlands; and Department of Psychology (M.A.L.), Wayne State University, Detroit, Michigan.

Address correspondence and reprint requests to Henriët van Middendorp, PhD, Department of Medical Psychology, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: H.vanMiddendorp@mps.umcn.nl.

Received for publication October 12, 2012; revision received May 7, 2013.

Copyright © 2013 by American Psychosomatic Society
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