Age, pain, and coping with rheumatoid arthritis

Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications

Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.

Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity

The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, M_age = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.

Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping

OBJECTIVE

As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.

METHODS

A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice.

RESULTS

We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.

CONCLUSIONS

To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.

How do I cope with pain? Let me count the ways: awareness of pain coping behaviors and relationships with depression and anxiety

Patients with chronic pain are often undertreated with medications alone and need alternative ways of coping. Identifying pain coping skills patients use may be beneficial; however, no research has investigated whether patients are aware of their coping skills. The purpose of this study was to determine whether patients are aware of their pain coping skills, whether certain patient characteristics were related to using coping strategies, and whether coping strategies were related to psychiatric symptoms. Chart reviews were conducted on seventy-eight chronic pain patients who completed a semi-structured psychological interview. Patients endorsed using more coping strategies on the measure compared to the verbal self-report. Identifying with certain patient demographics was related to higher use of some coping strategies. Symptoms of anxiety and depression were also related to the use of some coping strategies. Anxiety was negatively related to ignoring the pain and using self-talk coping statements and positively related to catastrophizing. Depression was negatively related to the use of distraction, ignoring the pain, and using self-talk coping statements. Depression and pain severity were both positively related to catastrophizing and prayer. Results suggest that clinicians may need to help patients become aware of adaptive coping strategies they already use and that the use of certain coping strategies is related to lower levels of depression and anxiety.

The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review

AIM

This systematic review examines how specific coping strategies are associated with psychological and physical outcomes in rheumatoid arthritis.

BACKGROUND AND METHODS

Rheumatoid arthritis is a long-term condition that people cope with but it is unclear whether specific coping strategies have an effect on mood and function. Therefore a systematic review was undertaken of the coping with arthritis literature and 174 studies were initially included. Further examination determined that 31 studies (11 longitudinal and 20 cross sectional) were finally included in the review. The 31 studies were clinically and methodologically diverse; therefore the analysis of results was a qualitative synthesis. Coping strategies that contributed to the prediction of outcomes were allocated to a new structure for the classification of coping.

RESULTS

The results demonstrated there was not sufficient, consistent evidence to support the overall view that individual coping strategies contributed to longitudinal outcomes in rheumatoid arthritis. However, major differences in the design of included studies may have hindered the comparison of results. There was some evidence from longitudinal studies that patients who used resting, inactivity, etc. (helplessness category) experienced negative outcomes. Avoidance (escape) was the most common overall category associated with predominantly negative outcomes in both cross-sectional and longitudinal studies.

CONCLUSIONS

There was generally limited evidence to suggest an association between coping strategies and outcomes but the design of studies and the lack of clarity about coping strategies were identified as problems. This study used a new framework for the conceptualisation of coping strategies, thus contributing to further examining the utility of coping strategies and contributing to their redefinition.

RELEVANCE TO CLINICAL PRACTICE

The use of helplessness (inactivity and passive coping) and escape/avoidant coping strategies, including denial and wishful thinking, could be identified and addressed by nurses and other health professionals to reduce the associated negative outcomes.

Sensory Sensitivity and Strategies for Coping With Pain

OBJECTIVE. Our goal was to investigate the relationship between sensory processing styles and use of pain coping strategies in an experimental setting to understand individual differences in pain coping.

METHOD. A cross-sectional design was used with a convenience sample of 116 healthy adults. Measures of sensory processing style and mood state were collected before participation in a cold pressor pain-inducement task, and measures of coping strategies were collected afterward. Multiple regression models were constructed to examine relationships between sensory processing and coping strategies.

RESULTS. Sensory sensitivity and sensation avoiding were significantly associated with higher levels of catastrophizing. Sensation seeking was linked with active coping strategies, such as coping self-statements. Low registration was not significantly associated with any particular coping strategy after controlling for salient variables.

CONCLUSION. This study highlights associations between sensory processing and pain coping strategies, which may inform more tailored approaches to clinical practice for people in pain.

Association between Disability and Psychological Factors and Dose of Neuromuscular Electrical Stimulation in Subjects with Rheumatoid Arthritis

BACKGROUND

The therapeutic effect of neuromuscular electrical stimulation (NMES) on muscle strengthening and hypertrophy depends on its dose. Patients must tolerate high doses of NMES to maximize gains in muscle function. It is unknown why some patients are able to achieve high NMES dose while others are not. Disability and psychological attributes may play a role in a patient's tolerance of NMES dose.

PURPOSE

To explore if disability and psychological attributes associate with the ability to achieve high doses of NMES in patients with rheumatoid arthritis (RA).

METHODS

Cross-sectional study. Forty subjects with RA participated in 2 sessions of NMES intervention to the quadriceps muscles. The highest NMES dose achieved by each subject was recorded. Dose was defined as the torque produced by the NMES as a percentage of the torque produced during a maximum voluntary isometric contraction. Subjects were then grouped in high or low NMES dose. Variables investigated in this study included disability, pain coping strategies, pain acceptance, sense of mastery or control, anxiety, and depression. Correlations were sought between these factors and NMES dose.

MAIN RESULTS

In unadjusted models, disability, coping self-statements, catastrophizing, and anxiety were predictors of NMES dose. In adjusted models only disability (OR = 0.17 [95% CI: 0.04, 0.77]) and catastrophizing (OR = 0.85 [95% CI: 0.72, 0.99]) predicted NMES dose.

CONCLUSION

Patients with RA with lower disability and lower catastrophising achieve higher doses of NMES. Identifying factors associated with achieving high NMES dose may guide strategies to improve effectiveness of this intervention.

Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample

The purpose of this study was to assess the relative effects of coping self-efficacy and catastrophizing on physical functioning. Over a 9-month period, studying changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target. Data came from a randomized, longitudinal controlled trial comparing exercise, self-management and the two combined to treat 254 individuals with early knee osteoarthritis. A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects. Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing. Treatments targeting both self-efficacy and catastrophizing may have greater impact on physical functioning compared to treatments that focus on only one.

Differences in the use of pain coping strategies between oncology inpatients with mild vs. moderate to severe pain

The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of <or=4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n=224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores (P=0.04) and significantly lower ratings of overall health (P<0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing (P<0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies (P=0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar.

Reactions to disability in patients with early versus established rheumatoid arthritis

OBJECTIVES

This study examined differences in reactions to disability between early and established rheumatoid arthritis (RA) patients, and whether these reactions were related to age, physical functioning, acceptance of illness, or self-efficacy.

METHODS

Thirty-four patients with early RA (< 2 years since diagnosis) and 84 patients with established RA (> 4 years since diagnosis) completed the Reactions to Impairment and Disability Inventory (RIDI), and measures of anxiety, depression, acceptance of illness, self-efficacy, and physical functioning.

RESULTS

Early RA patients reported greater future denial than established RA patients. Younger patients reported more hostility than older patients. Accepting the illness was uniquely related to less anger and hostility. Higher self-efficacy for pain specifically related to greater shock, while patients with poorer self-efficacy for other symptoms reported worse anxiety, depression, shock, and anger.

CONCLUSIONS

Denial may be a coping strategy in the early stages of RA: anxiety, depression, shock, and anger appear to persist. Longitudinal studies of RA patients from diagnosis are required to plan interventions timed to maximize patient benefit and optimize healthcare resource utilization.

Greater Perceived Helplessness in Osteoarthritis Predicts Outcome of Joint Replacement Surgery

Objective.

To determine if there is a difference between male and female patients in their perceived control of osteoarthritis (OA) symptoms at the time of joint replacement surgery, as measured by the Arthritis Helplessness Index (AHI), and how this helplessness affects surgical outcomes at 1 year.

Methods.

From a joint replacement registry, 70 male and 70 female patients were randomly selected and matched for age, body mass index, comorbidity, procedure, and education. Patients completed the AHI prior to surgery. Functional status was assessed at baseline and 1-year followup with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Linear regression modeling was used to determine the effect of sex on predicting AHI scores. A second model was constructed to examine the effect of AHI on the 1-year WOMAC change score.

Results.

There were no statistically significant differences in demographic data or clinically significant differences in AHI scores between sexes. Linear regression modeling showed that female sex was a significant predictor of a greater AHI score prior to surgery (p < 0.05). Moreover, a greater AHI score was an independent predictor of a lower WOMAC change score at 1 year (p = 0.01).

Conclusion.

Interventions to improve control over arthritis symptoms should be studied with the goal of improving surgical outcomes.

Use of the Chronic Pain Coping Inventory to Assess Older Adults’ Pain Coping Strategies

Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population.

PERSPECTIVE

Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.

Concept analysis of coping with arthritic pain by South Korean older adults: Development of a hybrid model

This study was conducted to clarify and conceptualize the phenomenon of coping with arthritic pain by older adults. The Hybrid Model of concept development was applied to develop a conceptual structure of coping with arthritic pain by older adults. A refined definition of coping with arthritic pain by older adults emerged that identified the attributes and structure of the concept. This study reveals the characteristics of the ways that older adults cope with arthritic pain, such as how they experience themselves, how pain affects their daily life, and how they perceive the meaning of coping with arthritic pain. These characteristics indicate the complexity of the concept regarding the coping of older adults with arthritic pain. This area needs to be clarified when nursing staff assess coping with pain and plan pain management for older adults.

Coping strategies of HIV patients with peripheral neuropathy

The aim of this study was to evaluate the association between coping strategies and reports of with pain and distress in patients with HIV-related peripheral neuropathy. Seventy-eight HIV seropositive subjects completed the Coping Strategies Questionnaire (CSQ), a self-report measure that assesses seven factors, the Brief Pain Inventory (BPI), the Brief Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Bivariate correlations revealed that younger patients used more Praying-Hoping (r=-.23, p<.04) and Catastrophizing (r=-.30, p<.007). t-tests demonstrated that women used more Praying-Hoping (t(76) = 3.42, p<.01), while Hispanic and African American patients used more Praying-Hoping more than Caucasians (F (1,77) = 22.11, p=.0005). Catastrophizing significantly predicted higher scores on the BDI (t=2.968, p=.004), the Global Severity Index (GSI) of the Brief Symptom Inventory BSI (t=2.400, p=.02); and pain interference on the Brief Pain Inventory BPI (t=2.996, p=.004) controlling for age, gender, and ethnic background. These results demonstrate that coping strategies may differ according to age, gender, and ethnic background in an HIV population, and that Catastrophizing predicts distress and interference with functioning in this sample.

Psychological approaches to understanding and treating disease-related pain

Psychologists are increasingly involved in the assessment and treatment of disease-related pain such as pain secondary to arthritis or cancer. This review is divided into four sections. In the first section, we provide a conceptual background on this area that discusses the limitations of the biomedical model of disease-related pain and traces the evolution of psychosocial theories of pain. In the second section, we discuss special issues and challenges involved in working with persons having disease-related pain, including the reluctance of some persons to report pain and to become involved in psychological treatments for pain. Section three provides an overview of psychosocial research conducted on arthritis pain and cancer pain that addresses both psychosocial factors related to pain and psychosocial interventions for pain management. In the final section, we describe important future directions, including strategies for disseminating psychosocial treatments and disparities in pain management.

The role of opioid analgesics in rheumatoid disease in the elderly population

Adequate pain therapy is an important aspect in the treatment of the elderly patient with rheumatoid disease. Problems with traditional NSAIDs include potentially serious gastrointestinal, cardiovascular and renal adverse effects, especially in the elderly. In addition, the selective cyclo-oxygenase-2 inhibitors have been associated with renal and cardiovascular adverse effects which may limit their use in the elderly with renal or cardiovascular disease. Opioids provide a treatment option for the management of pain in elderly patients with rheumatoid disease in whom pain control under standard management is poor; however, various therapeutic difficulties are encountered in the heterogeneous elderly population (increased risk of adverse effects, multimorbidity, and polypharmacy). Lower initial opioid dosage, prolonged dosage intervals and slower dosage titrations are advisable because of altered pharmacokinetics and pharmacodynamics. Kidney function should be tightly monitored and a timely use of laxatives is to be encouraged. Randomised clinical studies of opioids in musculoskeletal pain (e.g. osteoarthritis) have increasingly extended the scientific basis for their use. However, no randomised controlled clinical trials have examined the efficacy and the benefit/risk ratio of opioids in rheumatoid arthritis. Opioids also demonstrate an analgesic effect following local peripheral application. This opens the way to new therapeutic options in the future through the development of systemic peripherally selective opioids without CNS adverse effects.

Identification of Strategies Used to Cope with Chronic Pain in Older Persons Receiving Primary Care from a Veterans Affairs Medical Center

OBJECTIVES

To identify the strategies used by older persons to cope with chronic noncancer pain, determine the perceived effectiveness of the strategies, and ascertain factors associated with their use.

DESIGN

Cross-sectional telephone survey.

SETTING

Primary care practice located at a Veterans Affairs Medical Center in New England.

PARTICIPANTS

Two hundred forty-five patients (aged 65-90) with chronic pain.

MEASUREMENTS

Qualitative methods were used to ascertain participants' coping strategies, and their effectiveness was determined using a five-category response scale (1=not at all effective to 5=extremely effective). In multivariate analyses, associations between participants' demographic, medical, psychosocial, and pain characteristics and prevalent coping strategies were assessed.

RESULTS

Participants had a mean age+/-standard deviation of 75+/-5.1; 84% were male. Overall, 240 (98%) participants had employed at least one coping strategy in the previous month; the mean number used per participant was 2.8+/-1.4. Prevalent coping strategies included analgesic medications (used by 187/240=78% participants), exercise (35%), cognitive methods (37%), religious activities (21%), and activity restriction (20%). The proportion of participants who used a given strategy and rated it quite a bit or extremely effective exceeded 50% for only five of the 15 identified strategies. Women were more likely than men to use cognitive coping methods (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.5-6.8) and religious activities (OR=2.6, 95% CI=1.2-5.7). Participants with chronic pain due to a musculoskeletal cause were more likely to use analgesic medications than those with pain due to all other causes (OR=3.2, 95% CI=1.6-6.4), whereas those with trauma-related pain were less likely to use exercise than those with pain due to all other causes (OR=0.2, 95% CI=0.1-0.7).

CONCLUSION

Older primary care patients use a broad variety of coping strategies to cope with chronic pain. Studies are needed to confirm these findings in other older populations and to characterize the longitudinal effects of the coping strategies. Given the finding that the perceived effectiveness of most coping strategies was modest, efforts to increase their effectiveness in older persons are indicated.

Confronting life with rheumatoid arthritis

BACKGROUND

Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife.

AIM

The purpose of this study was to identify and describe, at three points in time and over two 6-month intervals, the illness-related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress-related emotions and the coping strategies they used to manage the illness-related stressors.

METHODS

A longitudinal, descriptive design was used to assess older people's perceptions of illness-related stress, their stress emotions and the coping strategies used to manage the illness-related stressors. Findings. The majority of participants most frequently identified physical limitations as their illness-related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis.

CONCLUSIONS

The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.

Coping strategies and life satisfaction in subgrouped fibromyalgia patients

The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis

This article provides an overview of the emerging literature on biopsychosocial assessment and treatment for two of the most common forms of arthritis: osteoarthritis and rheumatoid arthritis. The article is divided into 3 parts. In the 1st part, the basic elements of the biopsychosocial approach to assessing and treating persons having arthritis is described. In the 2nd part, the authors evaluate studies of biopsychosocial approaches to the assessment of arthritis pain and disability. Six research areas are reviewed: learned helplessness, depression, stress, pain coping, self-efficacy, and the social context of arthritis. The 3rd part of the article reviews studies that testing the efficacy of biopsychosocial treatment approaches for persons having osteoarthritis and rheumatoid arthritis.

Seniors' decision making about pain management

BACKGROUND

Musculoskeletal pain is a problem with which many seniors must contend, many on a daily basis. Little is known, however, of the self-care decisions that seniors make regarding the management and control of this pain. These decisions can influence in a significant manner the delivery of health care to seniors and their overall health and well-being. Purpose. The purpose of our exploratory-descriptive study was to investigate seniors' decision making regarding the management and control of musculoskeletal pain by gathering data about the context of decision making, the types of decisions seniors made, their decisional conflict and the resources they used in decision making.

METHODS

Focus groups and a mail-back questionnaire were used. Data were gathered in 1997 from a convenience sample of 50 seniors in Canada who experienced musculoskeletal pain of a noteworthy nature.

RESULTS

Findings revealed that participants made decisions within a context of ageing and the health and social consequences of advancing age. The types of decisions they made included to ignore their pain and to use distraction. They also used exercise, the application of heat and cold, and medications to manage pain. Decisional conflict was minimal and consultation with family and friends superseded that with professionals.

CONCLUSIONS

This study contributed to knowledge of decision making in later life about health matters generally, and the management and control of pain specifically. Findings point to the resourcefulness of seniors with respect to self-care and decision making. Seniors want to make informed decisions. However, they need information about the risks and benefits of decisions.