Fellowships Grants and Awards March 2004 Toxicogenomics

The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent evidence for psychosocial approaches to managing arthritis pain. By definition, psychosocial factors refer to two dimensions of experience: the psychological (cognitive, affective) and social (interacting with others, engaging in life activities). Psychosocial factors influence the perception of pain and the presence of pain influences psychological well-being and social participation. After discussing the impact of arthritis pain on participation in work, family life, and leisure, evidence for psychosocial interventions is summarized, emphasizing reviews and studies published from January 2000 to August 2006. Introduction Pain is a relatively common and troublesome feature of arthritis. The proportion of people with arthritis and related conditions who report experiencing moderate to severe pain is threefold that reported by people with other chronic conditions [1]. The relationship between psychosocial factors and pain is complex and multidimensional: psychosocial factors influence the perception of pain and the presence of pain influences psychological well-being and social participation. The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent evidence for psychosocial approaches to managing arthritis pain. Given the complexity of persistent pain and the cumulative literature on mechanisms and management, a biopsychosocial perspective has been adopted to explain this phenomenon [2]. Such a perspective maintains the important contribution of biological mechanisms to the pain experience, but adds the equally important psychological and social dimensions as both contributors to the pain experience and targets for intervention. Before proceeding, a few definitions may be helpful. ‘Psychosocial’ is a broad term incorporating both psychological (for example, cognitive and affective) and social (for example, interacting with others, engaging in life activities) dimensions. Terms pertinent to the discussion of psychosocial aspects of arthritis pain are defined in Table 1. Not unlike pain, assessment of many psychosocial factors relies on self reports of feelings and perceptions, while others may be inferred from observed actions or behaviors. Reliable and valid methods of measuring psychosocial factors are available [3] and many psychosocial factors are modifiable with education, skills training or therapy [3,4]. As a result, there is a considerable body of literature examining relationships among psychosocial and other factors potentially associated with arthritis pain, disability, and quality of life. This paper is structured in two parts. It begins with an overview of the psychosocial impact of arthritis on daily activities, to serve as the context against which intervention effects should be considered. This is followed by a description of the search strategy for reviewing psychosocial interventions, review of studies, and concluding statement. Psychosocial impact of arthritis Most types of arthritis require people to cope with pain, stiffness, fatigue, and physical limitations. The way they manage these aspects of their illness influences their ability to engage in meaningful, obligatory and discretionary activities, including the domains of work, family life, leisure, and social relationships. As social beings, with specific roles and responsibilities, humans engage in a range of life activities. Pain, along with other symptoms from arthritis, threatens the ability to participate in these activities [5] and may compromise psychological and social well-being [6]. Among a group of older adults with arthritis, those with greater pain disability experienced more psychological distress, higher unemployment and lower self efficacy [7]. Three life domains will be described here: work, family life, and leisure. Review Arthritis and pain Psychosocial aspects in the management of arthritis pain