Solicitous and invalidating responses are associated with health-care visits in fibromyalgia

A bio-what? Medical companions' perceptions towards biosimilars and information needs in rheumatology

Patient perceptions influence biosimilar uptake in non-mandatory transitions. Companions (support people) are often actively involved in the patient's medical journey and are likely to have unique perceptions of biosimilars, which may shape patient attitudes. This study explores the congruence between patient and companion perceptions towards biosimilars and their information needs. Patients taking bio-originators for rheumatic diseases (59% for rheumatoid arthritis) and their companions received an explanation about biosimilars. Participants (N = 78) completed questionnaires assessing their familiarity with biosimilars, perceptions, concerns, and benefits of being accompanied. Contingency tables and paired sample t-tests were used to explore differences in familiarity, confidence in knowledge, and perceptions. Intra-class correlation coefficients were calculated to assess the degree of congruence for perceptions towards biosimilars. Companions were significantly less familiar with biosimilars (p = 0.014, Cramer's V = 0.28) and reported lower confidence in their knowledge (p = 0.006, Cohen's d = 0.47) than patients. Companions and patients had moderate to good congruency for perceptions toward confidence in biosimilar use and safety, efficacy, and side-effect expectations (intra-class correlation coefficients ranging from 0.75 to 0.81). Companions and patients were most concerned about safety and effectiveness. Companions also reported concerns about cost savings driving the transition, while patients had concerns about uncertainty and testing. Patients reported the ability for discussion, improved understanding, and validation as benefits of being accompanied. Companions and patients have similar levels of perceptions and expectations towards biosimilars but report some unique information needs. Future educational interventions should involve companions and address their concerns to help improve biosimilar acceptance.

Invalidation in fibromyalgia and rheumatoid arthritis and its effect on quality of life in Indian patients

AIM

Fibromyalgia (FM) and rheumatoid arthritis (RA) patients face invalidation in the form of "discounting" and "lack of understanding". Invalidation can have effects on the quality of life (QoL) in these patients. We planned this study to look for invalidation in FM and RA Indian patients and see the correlation between invalidation and QoL.

METHODS

Invalidation was measured by the Illness Invalidation Inventory (3*I) to look for "discounting" and "lack of understanding" across sources, that is, spouse, family, medical professionals, work environment. QoL was measured using the World Health Organization QoL-BREF (WHOQoL). It covers mental, physical, psychological, and environmental domains.

RESULTS

Fifty-five FM and 102 RA patients were included in the study. Compared to RA, FM patients had significantly higher discounting by spouse, family and medical professionals (P < .001). FM patients suffered more lack of understanding from spouse and medical professionals as compared to RA patients (P < .001). In RA patients discounting by spouse had weak to moderate negative correlation with psychological, social and environmental domains of WHOQoL (r -.26 to -.48). Lack of understanding by spouse had moderate negative correlation with all the domains of WHOQoL (r -.30 to -.40) and a weak correlation with disease duration (r .23) in RA. In FM discounting by spouse and medical professionals had weak to moderate negative correlation with the physical health domain of WHOQoL (r -.26 to -.30).

CONCLUSION

FM patients faced more invalidation as compared to RA patients. Invalidation from spouse leads to poor QoL in RA and FM patients.

Two sides on the fibromyalgia coin: physical pain and social pain (invalidation)

Although fibromyalgia (FM) has been traditionally defined by the extent of physical pain sites alongside other non-pain symptoms, recent evidence has highlighted the importance of social dimension in definition of pain perception. Social pain or invalidation, which denotes painful feeling following social conflicts or misunderstanding about illness legitimacy, is an important but ignored issue in the FM lexicon. While physical and social pain seem to be different and separate entities, we hypothesize that they are completely intertwined with indistinct borders in FM. Accumulating emergent neuroscience and behavioral evidence highlights the overlapping of physical and social pain in different painful conditions. However, this overlapping seems to reach its maximum in FM. This review sheds more light on the tight interconnectivity between physical and social pain in FM from the perspective of intuitional commonalities, clinical aspects, and shared neural pathways. The conceptualization of FM as an integrative physical-social pain paradigm will move us closer to necessitating the incorporation of social pain in future models of FM diagnosis and management. Key Points • Considering of social pain as one key concept is relatively mute in FM literature. • Overlapping of physical and social pain seems to be unique in FM due to its nature. • Acknowledging social pain in the FM lexicon could shift the paradigm of diagnosis and management of FM patients.

Anxiety, Reinforcement Sensitivity and Social Context in Accepting the Experience of Pain Among Rheumatoid Arthritis Patients

Background: Acceptance has become one of the most widely studied processes regarding chronic pain because of its ability to influence participants' adaptation and coping responses. Leading researchers have found relationships between variables such as anxiety, reinforcement sensitivity, and the responses of the participants' environment to their behavior and acceptance. In contrast, few studies have been found that investigate the variables that predict the acceptance of pain. This study has set out to explore the relationships between pain-related anxiety, sensitivity to contingencies, and the punishment responses of significant people toward pain behaviors regarding pain acceptance. Methods: With a view to fulfilling this purpose, a cohort of 62 participants with rheumatoid arthritis was chosen, and the subjects were assessed through the following self-report measures: Chronic Pain Acceptance Questionnaire, CPAQ; Pain Anxiety Symptoms Scale, PASS-20; The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, SPSRQ, and The West Haven-Yale Multidimensional Pain Inventory, WHYMPI. The study's initial objectives were achieved by means of a stepwise multiple linear regression analysis. Results: The linear regression analyses revealed a negative and significant correlation between anxiety, reinforcement sensitivity, and the significant persons' responses to pain behaviors and pain acceptance. Conclusion: The results suggest that the identification of these variables might be important for addressing these participants' pain. Finally, the discussion focuses on our findings' implications as regards their use in clinical practice.