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Arthritis Disability Could Be Reduced By
Counseling, Coping Skills
13 May 2007
Arthritis
sufferers who undergo psychological counseling and learn skills for
coping with pain have less disability and better quality of life,
according to a new systematic review.
Living
with the pain of arthritis can lead to depression and isolation.
Severely afflicted people are often unable to socialize or participate
in favorite activities. Limited mobility and loss of fine-motor
function can make hard it to perform everyday tasks, like cooking or
getting dressed.
Treatment
early on aimed at psychosocial issues could make a big long-term
difference for people with arthritis, the reviewers say.
"This
early-intervention approach could have many benefits in terms of
preventing problems in coping from developing and [then] becoming
entrenched," said review co-author Francis Keefe, Ph.D., of Duke
University Medical Center.
The
review analyzed 27 randomized controlled trials involving 3,409
patients with osteoarthritis or rheumatoid arthritis to look at how
psychosocial interventions affected pain.
The
review, which is part of a new series, appears in the May issue of the
journal Health Psychology. Each evidence-based review centers on a
specific psychological assessment or treatment conducted in the context
of a physical disease process or risk reduction effort.
Studies in
the review paid the most attention to cognitive-behavioral therapy - a
treatment based on changing unhelpful patterns of thinking - for pain
management. An important facet of this therapy was training in specific
coping skills, such as using relaxation techniques and pacing daily
activities.
Other
interventions included biofeedback, stress management, emotional
disclosure, hypnosis and psychodynamic therapy.
Counseling
and coping skills made the greatest difference in quality of life
measures: patients who received the interventions reported a
significant decrease in anxiety, depression and psychological
disability.
Patients
who received psychological treatments also had significant reductions
in physical disability and joint swelling, although there was no
difference in levels of fatigue or stiffness.
More
women (69 percent) participated than men did. The average age was
nearly 59 years and 81 percent of the participants were white.
Therefore, the results are not universally applicable to men, minority
groups or people outside of middle age, the authors say.
The
number of study patients that reported reduced pain was not
statistically significant, but the authors say that although "the
effect sizes for pain are small…for the most part, these effects occur
in addition to those produced by standard medical care." The non-drug
methods studied "are presumed safer" than medications, they add,
another plus for psychological treatments.
"The
goal is rehabilitation - to reduce disability - not a cure for chronic
pain," said Patricia Dobkin, Ph.D., an associate professor of medicine
at McGill University in Montreal who was not involved with the review.
"When working in pain clinics, one often notes that even when pain
intensity is not reduced significantly, patients can and do learn to
live better with their pain," she added.
Given
the different approaches and treatment options available to patients
with arthritis, Keefe said, "If patients begin to develop problems
coping with persistent pain, they could ask their health care provider
to refer them to a psychologist who specializes in pain coping skills
and cognitive behavior interventions."
Over
43 million adults in the United States have an arthritis diagnosis and
another 23 million adults report symptoms of arthritis, making the
disease the leading cause of pain and disability in the country.
Arthritis is also a major contributor to workplace disability.
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