Psychological aspects of pain in rheumatoid arthritis: A review

Psychodynamic, Time-Limited Group Therapy in Rheumatic Disease – a Controlled Study with Special Reference to Alexithymia

“…psychosocial problems tend to reinforce each other interdependently. And -intricately connected with the premorbid presonality structure -the result may be a formation o f 'the vicious circle of pain' [7], So far most programs of patient educa tion and multidisciplinary group advice fo cus primarily on imparting information and mediating knowledge in order to encourage insight in and acceptance of the disease [8]. However, the widespread psychic difficulties among RA patients suggest that many people with rheumatic diseases are actually exper iencing recurrent psychological crises.…”

Therapeutic exercise in rheumatoid arthritis

“…However, pain perception is also influenced by psychological factors [29]. The associations between pain and emotional, cognitive, and behavioral factors are certainly not straightforward.…”

The nursing management of pain in the community: a theoretical framework

“…The bterature on stress has highlighted the importanee of uncertamty, unpredictability and fjerceived eonhol over events as determmants of responses to stress (Stokols 1985) Jams (1962 proposed that the person threatened with loss of eontrol over a situahon would stnve to regam eontrol, but if unsueeessful would develop feelmgs of helplessness and depression whieh impede physieal recovery Uneontrollability has been assoaated with both anxiety and depression, and Seligman (1975) has presented eonsiderable evidenee m favour of uneontrollability (ieamed helplessness) as a cause of depressive state usmg an animal model Skevmgton (1983a) identified perceived control, not cmly over pam but also over the situations in which chronic pam patients find thranselves, as a centra] issue for dironic pam research Skevington (1986) rqjorted that athtudes, beliefs and expectahons about pam, illness and ihe control oi pam had not yet been examined m any systemahc way but asserted that per(xphons of control are likely to be important to mental h^th, pan relief aiul ainbty to co{» with the disease Control appears to be synonymous with copmg accordmg to the definihon given by Vogel (1985), and these terms are used mterchangeably throughout this paper From the pahent's pomt of view, to cope with pam is to gam or mamtam eontrol over it, even though the pam itself may persist The workmg definihon of eontrol used by these authors is 'the emission of responses which are required to mamtam physiological and/or ecological homeostasis' This is a proeess of adaptation and is dependent upon leammg Leammg, m tum, depends upon the reeeipt of extemal information about events via the senses and mtemal mformahon fi-om direet feedback, and the processmg of this mformahon m relahon to existing knowledge Contemporary leammg theory mdicates that we leam about the probabdity of occurr«ices or outcomes (Dicbnson 1980) From this we may deduce that, if the probability of an event ocrumng, or of gammg a desirable outcome, is only at the level of chance, an mdividual will be unable to predict an appropnate response with any accuracy and the event may be imcontroliable For example if a pam occurs mtermittently at irregular mtervals for no identifiable reason, and vanes m its respcmse to treatment, there is very little possibility of gainmg control m totns of aehievmg pam relief A low probability of beu^ able to predict an appropnate response to pam or any other event mevitably eauses uncontrollabiiity, whereas a high probabibty of predicting a suitable response usually leads to control over the situahon and avoids stress…”