Pain management in rheumatoid arthritis patients

Abstract

To examine the effectiveness of a cognitivebehavioral pain management program for patients with rheumatoid arthritis, three patient groups were studied: a cognitive-behavioral group (CB), an attention-placebo group, and a control group. The CB group received a comprehensive, 12-month pain management program that taught coping strategies such as problem-solving techniques, relaxation training, strategies for attention diversion, and training in family dynamics and communication. Dependent measures included pain, coping strategies, psychological status, functional status, and disease status. Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies. Specifically, the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain. The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis.

Psychological interventions for rheumatoid arthritis: A meta‐analysis of randomized controlled trials

“…Five of the 25 studies (30,37,41-43) described a proper method of randomization (e.g., table of random numbers, computer generated). Patients were deemed to be blind to the treatment condition in 5 trials (27,30,37,38,43), although as noted earlier, such blinding is typically either not possible or not ethical in many behavioral interventions. Following von Tulder et al (20), in studies that utilized an attention control as the placebo condition, we considered patients to be blind if the researchers performed a treatment credibility analysis and there were no significant differences between the intervention or control group in terms of the participants' assessment of credibility.…”

Coping with arthritis: Current status and critique

“…Study results have been less consistent regarding the role of behavioral coping and cognitive restructuring strategies. In some studies (14,18), active strategies such as information seeking and "active coping" have been associated with a better outcome, while in other studies (13,26), the associations were not significant. Attempts to reinterpret pain sensations or to engage in coping self-statements (which is included in the Coping Attempts subscale of the CSQ) have not been associated with psychological distress in studies of chronic pain (21); however, cognitive restructuring has been associated with lower psychological distress in studies using the wac questionnaire (14).…”

“…For arthritis patients, psychological interventions that focus on improving coping skills have demonstrated significant reductions in levels of both psychological and physical disability, as well as pain levels (2,3), across populations that vary in socioeconomic status and medication use. Although coping behaviors may play an important mediating role between the stress of arthritis and its course and progression in individual patients, studies examining the relationships between coping and illness outcomes are few.…”

Effects of stress management on clinical outcomes in rheumatoid arthritis

“…After a comprehensive cognitive-behavioral intervention in RA patients, O'Leary et a1 (8) found benefits in the areas of pain, self-efficacy, and joint impairment. Parker et a1 studied the effectiveness of cognitive-behavioral pain management techniques (9), and found improvements in self-efficacy, pain, and helplessness in a subgroup of RA patients who were highly adherent to their treatment regimens. Radojevic et a1 (10) found decreased joint swelling in RA patients after a familyoriented, behavior therapy intervention.…”

“…Only Bradley et a1 (6) and Parker et a1 (9) have found GlZmonth benefits on a limited range of variables, so there is a compelling n e e d to develop psychoeducational programs that have enduring effects.…”