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Psychological Treatment for Pain

Chronic pain, physical limitations and joint deformities can have great psychological and emotional effects on a person with arthritis. In fact, living with arthritis can lead to such problems as depression, anxiety and helplessness, all of which can exacerbate pain and disability. Psychosocial interventions that help people deal with the pain and disability may be able to enhance quality of life for those affected by arthritis.

What Problem Was Studied?

Pain is the most frequently reported symptom of osteoarthritis (OA) and rheumatoid arthritis (RA), the two most common forms of arthritis. Past Arthritis Foundation grant recipient Francis J. Keefe, PhD, and his colleagues at Duke University Medical Center in Durham, N.C., sought to determine whether psychosocial interventions affect pain levels in people with arthritis. They also sought out information on the effects of these interventions on psychological function (anxiety, depression, active coping, etc.), physical function (disability, fatigue, stiffness) and biological function (joint swelling, disease activity).

What Was Done In the Study?

Keefe and colleagues systematically reviewed results of studies investigating the effects of psychosocial interventions for OA and RA. The team ran computer searches to find all the published results of relevant randomized, controlled trials of psychosocial interventions. The interventions included in the search were cognitive-behavioral therapy (CBT)/pain coping skills training, biofeedback, stress management, emotional disclosure, hypnosis and psychodynamic therapy. The main endpoint that they looked for in the studies was self-reported pain intensity.

What Were the Study Results?

All told, 233 articles were identified and reviewed. Of those, 31 met all the inclusion criteria; four of those were follow-up reports of included studies, yielding 27 distinct studies for inclusion in the meta-analysis. The most frequently tested intervention was CBT for pain management/pain coping skills. The other interventions were tested very infrequently, which prevented meaningful comparisons between interventions.

Overall, psychosocial interventions had a small, but statistically significant, effect on arthritis pain. These interventions had their strongest effects on active coping, followed by anxiety and joint swelling.

What Do These Results Mean for People with Arthritis?

Keefe wants people with arthritis to be aware that, “although psychosocial interventions appear to have some effects on pain, these treatments are most likely to enhance their quality of life by producing improvements in other important areas such as coping, anxiety, pain self-efficacy, depression, joint swelling and physical disability.” He goes on to encourage the availability and use of these treatments to “prevent and reduce unnecessary pain and suffering.”

Dixon KE, Keefe FJ, Scipio CD, et al. Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychol 2007;26:241-50.


Psychology Basics

Psychosocial intervention:Therapies involving aspects of social and psychological behavior.

Cognitive-behavioral therapy: CBT for pain management usually consists of three phases:

  1. education about the biopsychosocial model of pain;
  2. skills training during which a variety of methods are practiced, including relaxation techniques, activity pacing, pleasant activity scheduling, imagery techniques, distraction strategies, cognitive restructuring (changing negative thought patterns), problem solving and goal setting;
  3. application phase during which participants practice and apply the skills in real-life situations.

Active coping: Active coping is characterized by solving problems, seeking information, seeking social support, seeking professional help, changing environments, and planning activities in response to some stress, physical or emotional. This is in contrast to avoidant coping strategies, which lead people into activities (such as alcohol use) or mental states (such as withdrawal) that keep them from directly addressing stressful events.

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