The role of state and trait positive affect and mindfulness in affective reactivity to pain in chronic migraine.

OBJECTIVE: High affective reactivity to pain (i.e., increased negative affect in response to pain) can have an adverse impact on the well-being of individuals with chronic pain. The present study examined the role of momentary and average positive affect and trait mindfulness in protecting against affective reactivity to chronic migraine-related pain. METHODS: The sample included 61 adults with chronic migraine. Following the experience sampling method, participants completed smartphone-based assessments of momentary pain intensity (PI), positive affect (PA), and negative affect (NA) at nine random moments a day for 7 consecutive days. The Five-Facet Mindfulness Questionnaire was used to assess two dimensions of mindfulness: nonjudging and nonreactivity. RESULTS: Momentary PA inversely predicted the strength of the concurrent but not the time-lagged associations between PI and NA. Average PA predicted neither the strength of the concurrent nor the time-lagged associations between PI and NA. Furthermore, the concurrent associations between PI and NA were weaker in individuals who reported higher "nonjudging" while "nonreactivity" did not significantly moderate these associations. CONCLUSIONS: Results provide partial support for the dynamic model of affect in the context of chronic migraine. State PA seems to play a larger role in momentary affective reactivity to chronic migraine-related pain than trait PA. Results also suggest that the ability to take a nonjudgmental stance toward negative experiences may lower momentary affective reactivity to pain. These factors seem promising targets for interventions aimed at improving the well-being of individuals with chronic migraine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Living with chronic headache: a qualitative study exploring goal management in chronic headache.

OBJECTIVES: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). METHODS: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. RESULTS: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a "persistence phase," characterized by the use of "resource-depleting" assimilative strategies to remain engaged in goals, (2) a "reorientation phase" in accommodative strategies were used to regain balance, and (3) a "balancing phase" in which a combination of "resource-depleting" and "resource-replenishing" assimilative strategies was used to maintain balance. CONCLUSIONS: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals.