Article: http://www.mooshee.com/article-2996518.htm
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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.

Article: http://www.mooshee.com/article-2996518.htm