Pain in Patients With Rheumatic Disease
Laurence A. Bradley University of Alabama at Birmingham
Patients with rheumatic disease view pain as one of the most important and challenging consequences of their illnesses ( Bradley, 1996). It has been found, for example, that pain is more important than physical or psychological disability in explaining medication usage among patients with rheumatoid arthritis (RA) ( Kazis, Meenan, & Anderson, 1983). Pain is also a significant predictor of patient and physician assessments of the patients' general health status as well as their future levels of pain and disability ( Kazis et al., 1983). However, perceptions of pain intensity and displays of pain behavior are not highly associated with measures of rheumatic disease activity such as joint counts ( Bradley, 1994a, 1994b). Indeed, it is quite common to observe patients in rheumatology clinic with few inflamed joints who display multiple pain behaviors (e.g., stiffness, guarded movement, grimacing) as well as patients with numerous inflamed joints who behave in a relatively stoic manner. Moreover, despite the advances that have been made in the medical management of the rheumatic diseases, patients rarely experience complete pain relief in response to their medication and physical treatment regimens ( Bradley, 1996).
Psychological and social variables affect patients' pain experiences ( Bradley, 1994b). Thus, optimal management of patients' pain problems can be achieved only if treatment providers recognize these psychosocial factors and can use the behavioral interventions that have been shown to influence these factors and reduce pain in patients with rheumatic disease. The primary purposes of this chapter are to (a) review the relationships that have