Counseling, coping skills could reduce arthritis disability

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.

Source: Center for the Advancement of Health

Related stories:

Aggressive treatment for whiplash does not promote faster recovery
Whiplash, the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in a significant burden of disability and health care utilization. Although there are few effective treatments for whiplash, a growing body of evidence suggests that the type and intensity of treatment received shortly after the injury have a long-lasting influence on the prognosis. A new study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined whether the association between early types of care and recovery time shown in an earlier study was reproducible with whiplash compensated under tort insurance.
Arthritis pain, the brain and the role of emotions
How does the brain process the experience of pain? Thanks to advances in neuroimaging, we now know the answer lies in a network of brain structures called the pain matrix. This matrix contains two parallel systems. The medial pain system processes the emotional aspects of pain, including fear and stress, while the lateral system processes the physical sensations—pain's intensity, location, and duration.
1 in 2 adults at risk for painful knee arthritis
A landmark government study suggests nearly one in two people (46%) will develop painful knee osteoarthritis over their lifetime, with the highest risk among those who are obese. According to the Arthritis Foundation, the study underscores the immediate need for the public to understand what they can do to reduce the tremendous pain, disability and cost associated with arthritis.
Got Gout? Duke Leads Study of New Treatment
(PhysOrg.com) -- A new drug designed to normalize levels of uric acid in the blood appears to be safe and tolerable and may help patients with the painful arthritic condition known as gout better cope with their disease, say researchers at Duke University Medical Center.
Researchers offer first direct proof of how osteoarthritis destroys cartilage
A team of orthopaedic researchers has found definitive, genetic proof of how the most common form of arthritis destroys joint cartilage in nearly 21 million aging Americans, according to a study published online Sept. 2 in the Journal of Bone and Mineral Research. The findings serve as an important foundation for the design of new treatments for osteoarthritis (OA), researchers said.
Suicide risks studied in drugs for physical ills
(AP) -- Cody Miller was a high school football player who was allergic to ragweed. Douglas Briggs was a doctor coping with pain from an old back injury. Both are now dead, hanging victims driven to suicide, their families believe, when drugs prescribed to relieve physical symptoms upset their mental and emotional balance. Federal drug regulators are investigating to see if the families could be right.
New test to diagnose osteoarthritis early
A newly developed medical imaging technology may provide doctors with a long-awaited test for early diagnosis of osteoarthritis (OA), scientists from New York reported today at the 236th National Meeting of the American Chemical Society. By far the most common form of arthritis, OA is a bane of the Baby Boom generation, causing joint pain and disability for more than half of those over 65 – nearly 21 million people in the United States.
Researchers discover how rheumatoid arthritis causes bone loss
Researchers have discovered key details of how rheumatoid arthritis (RA) destroys bone, according to a study published in the Aug. 22 edition of the Journal of Biological Chemistry. The findings are already guiding attempts to design new drugs to reverse RA-related bone loss and may also address more common forms of osteoporosis with a few adjustments.

News discussion:

Medicine & Health news