Predictors of psychological distress and well-being in women with chronic musculoskeletal pain: Two sides of the same coin? Alexa Huber a , Anna Lisa Suman a , Giovanni Biasi b , Giancarlo Carli a, ⁎ a Department of Physiology, Siena University, Siena, Italy b Department of Clinical Medicine and Immunological Sciences, Siena University, Siena, Italy Received 31 March 2007; received in revised form 10 September 2007; accepted 18 September 2007 Abstract Objective: To date, few results on well-being in chronic-pain patients have been published, while several studies in patients without pain have indicated that well-being may not be equivalent to absence of psychological distress. The aim of the present study was to investigate the relationship between psychological distress and well-being and to identify the predictors of each in patients with chronic nonmalignant pain. Methods: Sixty-nine women with chronic multiregional muscu- loskeletal pain, 41 of whom met American College of Rheumatology criteria for fibromyalgia, completed questionnaires on pain, fatigue, stiffness, physical disability (Fibromyalgia Impact Questionnaire), psychological distress [Multidimensional Affect and Pain Survey (MAPS), Symptom Check List-90 (SCL- 90), State–Trait Anxiety Inventory Form Y2 (STAI-Y2)], and hedonic and eudaimonic well-being (MAPS). Results: Patients reported increased amounts of psychological distress (STAI-Y2 and SCL-90) compared to healthy people. Multiple regression analysis of patient data demonstrated that higher psychological distress was related to higher age, more intense pain, a higher positive tender point count, and more physical disability. Well- being (both hedonic and eudaimonic aspects) decreased with higher disability, but was independent of age, pain intensity, and number of positive tender points. Bivariate correlations showed that psychological distress was moderately related to eudaimonic well-being and strongly related to positive affect, an aspect of hedonic well-being. Conclusion: In patients with chronic musculoskeletal pain, self-reports of well-being and low psycho- logical distress only partially overlap with each other and are differently related to major patient symptoms, supporting the relevance of the concept of well-being to chronic-pain research and a need for further studies in this field. © 2008 Elsevier Inc. All rights reserved. Keywords: Chronic disease; Fibromyalgia; Pain; Psychological stress; Suffering; Well-being Introduction In recent decades, health-related research and health care have focused on negative mental processes such as psychological distress and dysfunction, while positive mental processes such as psychological well-being have been much less studied [1]. According to some authors [2,3], this underscores a mistaken assumption that health can be equated with absence of illness and that well-being is equal to lack of distress. Yet, several clinical and experimental studies have shown that psychological distress and well- being are better construed as distinct, partly independent dimensions [3–6]. Psychological research distinguishes two broad concep- tualizations of well-being [1]: hedonic versus eudaimonic well-being. The hedonic tradition defines well-being as people's affective and cognitive evaluations of their lives [7], thus embracing positive affect as a defining feature of well- being. The eudaimonic tradition is exemplified in Ryff's [8] work on “psychological well-being.” Ryff defines well-being in terms of psychological functioning and personal growth, and has distinguished six dimensions: autonomy, environ- mental mastery, personal growth, positive relations with Journal of Psychosomatic Research 64 (2008) 169 – 175 ⁎ Corresponding author. Sezione di Neuroscienze e Fisiologia Appli- cata, Dipartimento di Fisiologia, Università degli Studi di Siena, Via Aldo Moro, 53100 Siena, Italy. Tel.: +39 0577 2340 39; fax: +39 0577 2340 37. E-mail address: carlig@unisi.it (G. Carli). 0022-3999/08/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2007.09.005