Increased inflammation affects specific neurotransmitter systems and many behavior disorders, Dr. Miller said. He also noted the importance of neurotransmission to mood regulation has led to the investigation of inflammation and inflammatory cytokines on serotonin, noradrenaline and dopamine levels, and also on the excitatory amino acid glutamate. In a study he led that appeared in Nature Reviews Immunology, he wrote, “There are several pathways through which inflammatory cytokines can lead to reduced synaptic availability of these monoamines, which is believed to be a fundamental mechanism in the pathophysiology of depression.”8
Mind-Generated Solutions
Afton L. Hassett, PsyD, associate research scientist in the Department of Anesthesiology and director of the university’s clinical pain research in the Back & Pain Center, University of Michigan, Ann Arbor, focused on how RA may adversely affect a patient’s mood and behavior. “What’s important,” she said, “is how we react [to the pain]. Do we bounce back, or are we bowled over?”
Numerous studies link negativity to key factors in chronic pain. Dr. Hassett said that compared with more positive people, those who think negatively tend to have:
- Higher clinical pain intensity;
- Higher pain reports;
- Worse weekly pain;
- Lower pain tolerance;
- Increased experimental pain sensitivity;
- Reduced tolerance to pain;
- Increased hyperalgesia;
- Greater use of pain medication;
- Increased analgesia;
- Greater pain-related disability;
- Increased fatigue;
- More physical symptoms;
- Greater impact of pain on cognition;
- Higher levels of psychiatric co-morbidity;
- Poorer quality of life; and
- Poorer self-efficacy for pain management.9–12
Dr. Hassett said it’s important for arthritis patients not to focus on the negative. “We psychologists and psychiatrists are fantastic at measuring negative symptoms. We’re great at understanding anxiety and depression and the impact of all these other negative emotions. And they’re important, because even in the area of pain, they’re very nicely related to all of the things we want to avoid. So patients who are depressed or anxious are more likely to higher pain report, use more medications and have greater levels of disability.”
A better approach is to not let patients wallow in their fears and other negative thought patterns. “We as humans are more than negative emotions; we are also full of positive emotions, and we’re resilient,” said Dr. Hassett.
People who tend to be resilient share certain characteristics. In general, they have positive self-images, have social support and other positive relationships, and have developed and use coping and problem-solving skills. They also have positive emotions. “They’re not just happy but also courageous,” said Dr. Hassett.
