Cognitive-behavioral treatment of rheumatoid arthritis pain: maintaining treatment gains.
OBJECTIVE: This paper critically reviews research studies examining the long-term effects of cognitive-behavioral therapy interventions for managing pain in rheumatoid arthritis patients. METHODS AND RESULTS: The first section of the paper evaluates long-term results obtained in studies of cognitive-behavioral therapy, arthritis education interventions, and combined cognitive-behavioral therapy-arthritis education interventions. These studies show that although some rheumatoid arthritis patients are able to maintain initial improvements in pain and disability, other rheumatoid arthritis patients do not. In the second section of this review, a cognitive-behavioral model of maintenance of pain coping skills is presented. This model may be useful in increasing our understanding of the relapse process and in planning interventions to enhance and prolong cognitive-behavioral therapy treatment gains. The final section of this paper addresses important future directions for research. The need for empirical studies of relapse and maintenance processes is underscored. CONCLUSIONS: Controlled studies are needed to test the utility of new cognitive-behavioral interventions designed to enhance the long-term maintenance of treatment gains in RA patients. We suggest that a focus on issues of relapse and maintenance may be just as important for medical and surgical interventions for rheumatoid arthritis pain, as it is for cognitive-behavioral therapy interventions.
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