Arthritis: Can psychological techniques help people cope better with the pain and the disease?

Psychological support can help to reduce the pain and disability caused by arthritis. Strategies that encourage self-management appear to be particularly helpful.

Rheumatoid arthritis – also known as RA – is a chronic inflammation of the joints and, like osteoarthritis (deterioration of the joints), it is a common health problem. In rheumatoid arthritis, the inflammation causes pain and joint stiffness. In osteoarthritis, the wear and tear of the joints leads to pain and increasing disability in everyday life. These inflammatory or “wear and tear” changes can affect one or more joints in the body, such as those in the hands, fingers, knees or hips. Osteoarthritis generally affects older people, whereas rheumatoid arthritis can also affect younger people. In both of these conditions, the pain often gets worse with age.

Apart from causing pain, arthritis can also make people feel helpless, depressed and anxious. This may stop them from doing everyday activities like shopping and household chores or from taking part in social activities.

Research on psychological support for people with rheumatoid arthritis

Researchers from the University of Leiden in the Netherlands analysed trials that tested the effects of psychological support in rheumatoid arthritis. They did a systematic review, analysing and summarising all of the reliable trials on this topic. That was important, because it is only possible to get a realistic picture of the advantages and disadvantages of a treatment if you analyse all of the trials together. You can find out more about how systematic reviews are done here.

The researchers included a total of 27 trials in their analysis. Various interventions were tested in the trials, such as relaxation training, physical exercises, stress management techniques and cognitive behavioural therapy – a psychological treatment approach. The aim of cognitive behavioural therapy is to help people learn to change their thought patterns and their behaviour so that they can cope better with their health problem in the future.

After considering all of the trials together, the researchers came to this conclusion: in the time following the intervention, people had somewhat less pain than those who had not had any support. They also had less disability, were more active and felt less depressed. Interventions that were based on the idea of self-management were particularly effective. These are strategies that involve learning to manage the symptoms and feelings caused by a medical condition on your own. People learn to set their own personal goals, try to achieve those goals, and then assess how successful they were themselves. This was especially effective in helping people to cope with feelings of depression and anxiety.

Psychological help for people with osteoarthritis

Researchers from Duke University in the United States wanted to find out whether psychological techniques such as behavioural therapy could help to relieve the symptoms of osteoarthritis too. They found 9 trials involving people who had osteoarthritis. The researchers concluded that this kind of intervention can relieve osteoarthritis-related pain somewhat. Other things improved too, such as levels of anxiety and depression, as well as the person’s overall ability to cope with everyday challenges and the stress associated with pain.

Because this is a relatively new field of research, there are not enough trials to compare the different psychological and psychotherapeutic interventions and draw conclusions about them.

The researchers did not look at potential adverse effects of psychological interventions.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)