This article provides an overview of the emerging literature on biopsychosocial assessment and treatment for two of the most common forms of arthritis: osteoarthritis and rheumatoid arthritis. The article is divided into 3 parts. In the 1st part, the basic elements of the biopsychosocial approach to assessing and treating persons having arthritis is described. In the 2nd part, the authors evaluate studies of biopsychosocial approaches to the assessment of arthritis pain and disability. Six research areas are reviewed: learned helplessness, depression, stress, pain coping, self-efficacy, and the social context of arthritis. The 3rd part of the article reviews studies that testing the efficacy of biopsychosocial treatment approaches for persons having osteoarthritis and rheumatoid arthritis.

The anterior cingulate cortex (ACC) has been implicated in both sustained attention (SA) and pain perception. Nonetheless, only a small body of literature has examined the relationship between SA and pain perception. This study utilized fMRI to examine activation patterns that emerged in the ACC in healthy participants and participants with chronic pain (due to osteoarthritis (OA) of the knee) while completing a sustained attention task with and without exposure to an acute painful stimulus. Independent component analysis (ICA) was used to determine groups of voxels within the ACC that covaried with performance on the SA task completed with and without exposure to a painful stimulus. In all participants, two distinct spatial patterns within the ACC were isolated that reflected (1) disrupted ACC activity when a painful stimulus was applied, or (2) emergent ACC activity when a painful stimulus was applied. In the healthy group, there were broadly distributed clusters of voxels within the ACC that were modulated by painful stimulation. But in the chronic pain group, a discrete focal region of the ACC was modulated by pain. These results demonstrate that ACC activity is modulated differently during tasks of SA and pain, and that acute pain in healthy participants and participants with chronic pain result in significantly different ACC activation patterns.

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Purpose To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. Clinical trial registration ClinicalTrial.gov: NCT01502891.