CHRONIC PAIN AND PSYCHOLOGIAL INTERVENTION

The Literature Reviews Of Psychological Intervention For Rheumatoid Arthritis Patient Kholipah (300881892)Upper Iowa University Term 5 (2018-2019)PSY 498 - Senior Project Dr. Angelis JK Chan The Role Of Psychological Intervention For Rheumatoid Arthritis Patient According to World Health Organization International League of Associations for Rheumatology (WHO-ILAR) they indicate that 1.5 million people in America suffering from rheumatoid arthritis and as much as 1% of worldwide population in 1985, and year after year the number of the patients has only climbed even more (ACR, 2015), which is up to three times as prevalent in women than man, and the average age of onset is between 30 to 60 years old (Garbut, 2012).

Arthritis has been around since ancient times, Rheumatoid arthritis is an autoimmune disease in which the joints (usually the joints of the hands and feet) are symmetrically inflamed, resulting in swelling, pain and often eventually causing damage to the inside of the joint. Autoimmune disease means the body attack itself by mistake, in which body immune system supposed to protect the body but becoming detective and attacking is not just foreign proteins, bacteria, and viruses, but also producing antibodies against itself.

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Patients with RA will show signs and symptoms such as swollen joint, pain (rheumatoid nodule), stiffness in the joints especially after waking up in the morning, limited movement, joints feels hot, fever, body Strength decreases, looks redness around the joint, Changes in size, Patients appear to be anemic. When this disease is active the symptoms can include fatigue, energy loss, lack of appetite, low grade fever, muscle and joint pain and stiffness.

muscles and joint susceptibility are usually most frequent in the morning. Besides that, the clinical manifestations of rheumatoid arthritis are very varied and usually reflect the stage and severity of the disease. Pain, swelling, heat, erythema and dysfunction are classic clinical features for rheumatoid arthritis. Systemic symptoms of rheumatoid arthritis are easily tired, weak, lethargic, tachycardia, weight loss, anemia The characteristic pattern of the affected joints is starting in the small joints in the hands, wrists and legs. Progressively regarding joints, knees, shoulders, hips, elbows, ankles, cervical spine. Rheumatoid Arthritis is chronic diseases and lifelong conditions. Arthritis is a disorder that affect joints and cause pain and inflammation, and RA is the second most type common type of arthritis, the joints most commonly affected are hands, feet, wrist and ankles, it typically occurs at the same joints and both side of the body. Therefore, if RA left uncontrolled it may lead to severe disability, joint deuteriation and decrease the quality of life, and the potential of comorbidities, include; infection, depression, anxiety disorder, cancer (specifically lymphoma and lymphoproliferative diseases, lung cancer and melanoma) and also gastrolienal (citation). There's no exact cause of Rheumatoid Arthritis, as a result there's no specific cure for the diseases. However, pharmacologic approaches somehow help reduce or minimize the symptoms of the disease, such as; pain and disability (ACR, 2015). Dealing with the chronic conditions and the unpredictable of Rheumatoid Arthritis (RA) there many patients still experience psychological distress, joints deuteriation, pain and poor quality of life persist in spite of such treatment, which is common among patient with RA (NLM, 2013). di sini di jelaskan tentang peranan Psychological interventions include, Education, pain management strategies, relaxation, Cognitive behavioral therapy (CBT), stress management and meditation. Therefore, I would like to focus in some intervention techniques, which is cognitive behavioral therapy, relaxation and mindfulness skills training. So, the objective of this article is intended to provide guidance for patient of Rheumatoid Arthritis (RA) with particular psychological intervention which has been examine by some study, American College Of Rheumatology (ACR), American Psychological Association (APA) and several literature reviews has been proved in its efficacy.Psychological Interventions Cognitive Behavioral Therapy Cognitive behavior therapy CBT is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. This type of therapy emphasizes that people can change the way they think to feel or act better even if the situation does not change (NLM, 2007). The effect sizes from metanalyses and reviews suggest that CBT as the best psychological therapy for patient with Rheumatoid Arthritis (RA). The literature reviews by shadick and his colleagues in 1993, conduct study investigating the efficacy of psychological intervention for patient with rheumatoid arthritis (RA) " these include Internal Family Systems-based Psychotherapy (IFS). IFS has not been the subject of randomized controlled trials and so its potential efficacy is unknown, and cognitive behavioral therapy (CBT). CBT for RA consist of cognitive and behavioral therapy; in term of cognitive part is concern to help patient to distance ..The strategies that they use involve a skill how to interpret with the situation that might lead to negative emotions and also teach patient to be more ..Cognitive therapy achieve change through combinations of challenging the accuracy of beliefs and their helpfulness. In term of behavior therapy is concern with the balanced approaches to activity, the strategies they use involves learn skills how to develop balance between rest and exercise and explicitly set goals. In this review they mention that mindfulness can be more effective than CBT If the patient was in last or severe stage or for patient who has history of depression. This literature review concludes that in the present, CBT was the effective and the most strongly empirically supported intervention for patients with RA (Sharpe L, Sensky T, Timberlake N, Ryan B, Brewin CR, Allard S. A blind. 2001),Finding of 2002 review by Astin, Buckner, Soeken, and Hochberg This review was focusing on examining the efficacy of psychological interventions for patient with Rheumatoid Arthritis (RA), these include, biofeedback, cognitive behavioral therapy. The methods that they adopt consist, random assignment, Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control, direction and nature of the outcome, etc. The first review conduct by Bradley in 1987, he claim that cognitive behavior therapy (CBT) was the best of psychological intervention for cure patient with Rheumatoid Arthritis (RA), 15 session within 6 months treatment, these included Social support”15 sessions with family or friends”active listening by group leaders”patients encouraged to develop coping strategies but not taught any skills Usual medical care, the outcomes of this CBT methods was effective in helping patients with RA; positive changes in pain and disease activity, which is one of the inclusion criteria that met to the literature conduct by Astin, Buckner, Soeken, and Hochberg in 2002 (Laurence, A., Bradley, P., Larry, D., & Karen, O., Robert, A., Morgan, P., Piano, M., 1987). Later on, the follow up review conduct by McCracken in 1991 and Parker at el in 1993 this both reviews has similar results in their findings, they conclude that cognitive behavioral therapy (CBT) was require and warranted, given the positive outcomes and pain reduction for patients with RA (McCracken, 1991). However, there was argument in the literature adopt by Kafee and Van horn in 1997, they noted that although CBT treatment was often giving positive outcomes in reduction pain and disability but only for short term, and they suggest that untuk melakukan test tidak hanya Satu atau dua interest tapi mencakup beberapa intervenes Dan di ikuiti oleh semua patient; maksudnya Abdallah bagi metals yang stadium awal ataupun mereka yang severe. Therefore, in the most recent narrative review, conduct by Albert and Bradley, they examine several interventions to see the efficacy, these include, cognitive behavioral therapy, education, exercise, stress management, relaxation and mediation, the result was indicates that cognitive behavioral therapy was the best intervention and were beneficial for many patients with Rheumatoid Arthritis (RA), in this review, the criteria well establish, as set forth by the American Psychology Association (APA) (ACR, 1996), included a demonstration of efficacy through at least 2 controlled outcome studies from different investigators.Understanding the commonalities of effective interventions will help us to identify the effective components of treatment.ReferencesAstin, J., Buckner, W., Soeken, K., & Hochberg, M., (2002, June 05). Psychological Interventions For Rheumatoid Arthritis: A MetaAnalysis Of Randomized Controlled Trials. Journal Arthritis Care And Amp; Research / Volume 47, Issue 3. Retrieve From College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum 1996; 39: 723" 31Bradley, LA, Alberts, KR. (1999). Psychological And Behavioral Approaches To Pain Management For Patients With Rheumatic Disease. Rheum Dis Clin North Am 1999; 25: 215" 32.Garbutt, C. (2012). Rheumatoid Arthritis History. News Medical Life Sciences. Retrieve from V., Maes, S., & Knittle, K., (2010, May 06). Psychological Interventions For Rheumatoid Arthritis: Examining The Role Of SelfRegulation With A Systematic Review And MetaAnalysis Of Randomized Controlled Trials. Journal Of Arthritis Care And Amp; Research/ Volume 62, Issue 10. Retrieve From W., Zale, E., Berman, S., & Malacarne, A., (2019). Physical Functioning And Mindfulness Skills Training In Chronic Pain: A Systematic Review. Journal Of Pain Research Volume 12:179-189, DOI: 10.2147/JPR.S172733. retrieve from A., Bradley, P., Larry, D., & Karen, O., Robert, A., Morgan, P., Piano, M., (1987). Effects Of Psychological Therapy On Pain Behavior Of Rheumatoid Arthritis Patients. Treatment Outcome And SixMonth Follow Up. Journal Of Arthritis &Amp; Rheumatoid Arthritis/ Volume 30, Issue 10. Retrieve from LM. Cognitivebehavioral treatment of rheumatoid arthritis: a preliminary review of efficacy and methodology. Ann Behavior Med 1991; 13: 57" 65.Murphy, J. (2017.March). Rheumatoid Arthritis. American College of Rheumatology. Retrieved from L. (2016). Psychosocial Management Of Chronic Pain In Patients With Rheumatoid Arthritis: Challenges And Solutions. Journal Of Pain Research 9 (Issue 1), DOI: 10.2147/JPR.S83653. Retrieve From L. (2013). Psychological Treatment for Rheumatoid Arthritis Works: Now We Need to Know What Elements Are Most Effective and for Whom. The Journal of Rheumatology, 40 (11) 1788-1790, Vol. 40, Issue 11. Retrieve from L, Sensky T, Timberlake N, Ryan B, Brewin CR, Allard S. A blind (2001), randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. U.S. National Library of Medicine. (2007, May 17). Cognitive Behavioral Therapy Treatments for Adults With Rheumatoid Arthritis (The SARA Study). Clinical Trials.GOV. Retrieve from