Servicio de Información Comunitario sobre Investigación y Desarrollo - CORDIS

Final Activity Report Summary - CHRONIC PAIN (Psychosocial aspects of chronic pain in rheumatoid arthritis)

Rheumatoid arthritis (RA) is an incurable auto-immune disease that affects many tens of millions of people worldwide (indeed, 1 % of the Western population). It is associated with a variety of distressing and debilitating symptoms, most notably pain. As a result of the disease and related distress, RA sufferers typically experience a wide range of daily stressors - difficulties performing household chores, impaired ability to work or hold a job, difficulties engaging in leisure or social activities, and even interpersonal tensions resulting from added burdens for friends and family members. Due to the lack of a cure, RA treatment focuses on the alleviation of symptoms and an attempt to maintain functional status.

As with other chronic pain conditions, psycho-social factors play an important, perhaps very important role, in disease progression. One factor that has been demonstrated to be important for pain and disability among patients with RA is social support.

The primary objective of my research was to investigate the role of social support and coping among patients with RA. More precisely, we examined how couples cope with the daily challenges of living with RA. We considered both the effects of different types of support (e.g. emotional versus practical), and of levels of satisfaction with support, on patients' pain and well-being. We also considered the potentially harmful effects of negative social exchanges on the physical well-being of patients. Dissatisfaction with support may arise not only because there isn't enough, but also as a result of ineffective help, or of criticism. We predicted that dissatisfaction with support would be associated with increases in pain severity.

The data collected from the arthritic patients and their spouses confirmed our hypotheses. We interviewed patients and their spouses and also phoned them twice a day for a week. During those phone calls, we asked about daily stressful events and also about the level and type of social support spouses offered to help patients with these events. Patients reported a decrease in pain severity when they felt satisfied with the support provided to them by their spouse. On the contrary, they reported an increase in pain severity when the spouse complained about them during the day. Importantly, these fluctuations in pain severity held after taking into account morning reports of pain. The data indicated that three types of social support had a positive and the strongest contribution to satisfaction:
(a) support focused towards giving the patient a different perspective on a problem (informational support);
(b) support geared towards helping him / her with daily chores that the patient could not take care by him/herself (instrumental support); and
(c) emotional support.
On the other hand, when spouses complained during the day, patients seemed to be dissatisfied with the support provided. We suggest that these may be general and important findings for people suffering from chronic disease pain.

From a more practical perspective, these results indicate that programs aiming to reduce pain levels in rheumatoid arthritis patients should include both patients and their spouses. More specifically, such programs might best focus on how to improve the spouses' skills in responding to the patients' needs, by teaching spouses to help patients see things from a different perspective, to help them out with everyday chores and, importantly, to help spouses learn how to show their emotions more effectively.

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