Boston, Mass. (Apr. 1) - Rheumatoid arthritis (RA) patients who have difficulty expressing their thoughts and emotions have greater disease activity and pain and lower physical functioning than their more communicative counterparts, according to a new study presented at the 24th annual scientific meeting of the American Pain Society (APS) in Boston, Massachusetts.
In a study of 90 patients with RA (mean age of 56.5 years), those who scored lower on their Social Skills Inventory, Arthritis Impact Measurement Scale and Daily Stress Inventory were more likely to report greater disease activity, lower physical functioning, more pain, and more psychological distress.1
RA patients are known to report high levels of interpersonal stress that interferes with their daily function, and high levels of stress are associated with disease severity in these patients. The new findings suggest that interventions to enhance social skills and reduce stress may be beneficial for such patients.
"Teaching people or giving them the opportunity to express their emotions could lead to less pain and greater function," says lead study author Cindy Scipio, a PhD candidate at Duke University Medical Center in Durham, North Carolina. Emotional disclosure can include teaching patients ways to interact with others and express themselves socially, stress management techniques including deep breathing, and cognitive behavioral interventions such as goal assessment, she indicates.
The study participants were part of an ongoing study of emotional disclosure and RA pain.
Due to the reported side effects of many currently available painkillers, such interventions are of growing importance. "In terms of people having problems with [coxibs], a more holistic approach to what is in your control and learning to use your emotions as a positive and flourish within a painful episode can be important," Ms. Scipio tells CIAOMed. "Patients may not have complete elimination of pain, but they can learn different ways to deal with their pain."
Roger B. Fillingham, PhD, associate professor in the division of public health services and research at the University of Florida in Gainesville, agrees with this approach. "We know that there are effective behavioral and psychological treatments that have few, if any, known risks. If implemented more widely, [they] may reduce doses needed of medications and complement the effects of drugs," says Dr. Fillingham, chair of the APS scientific program committee. "Non-drug alternative treatments are reasonable and appropriate until better drugs without side effects are developed."
Ethnic and racial differences play a role in ongoing pain and stress in lupus
In a related study presented here, researchers from Shands Hospital of the University of Florida, Gainesville, concluded that lupus patients who reported greater stress also had more intense daily symptoms; importantly, there were ethnic/racial differences in coping skills and factors that contribute to stress.2 Non-African-American lupus patients reported a greater reliance on religious support to cope with the stress and pain of the disease, whereas African-American patients observed that their expected severity of difficulties for the upcoming week was higher than that of their non-African-American counterparts, the study showed.
The 42 patients who enrolled in the trial (mean age 40; 15 African-American, 27 non-African-American) maintained daily diaries for 28 days followed by weekly diaries for 4 weeks. The study found that there were no differences between the two groups in terms of baseline disease severity or average daily symptoms.
" More severe disease and stress are associated with daily painful symptoms, and there are ethnoracial differences in expected severity of hassles and religious coping, but not in disease severity," conclude researchers from Shands Hospital. "Further studies of patients for whom stress leads [to] an increase in symptom severity and patients for whom symptom severity leads to stress increase seems warranted."
References:
- Scipio C, Keefe F, Anderson T, et al. Links between social communications skills and physiological and psychosocial functioning in patients with RA. Presented at: 24th Annual Scientific Meeting of the American Pain Society; March 30-April 2, 2005; Boston, Massachusetts. Poster No. 663.
- Logan, H, Graham M, Shyster J, et al. Ongoing Pain and Stress Among Lupus Patients. Presented at: 24th Annual Scientific Meeting of the American Pain Society; March 30-April 2, 2005; Boston, Massachusetts. Poster No 667.