Positive Emotion Induction for Pain Associated with Rheumatoid Arthritis- A Quasi-experimental Study

Abstract

Introduction: Rheumatoid Arthritis (RA) is a chronic disease and a substantial proportion of patients continue to suffer from chronic pain and disability despite standard pharmacotherapy. A substantial proportion of patients with RA also develop anxiety and depressive symptoms. Positive Emotion Induction (PEI) has been shown to reduce pain symptoms. Aim: To know the effect of positive emotion induction as an adjunctive intervention on RA associated pain and disability. Materials and Methods: The longitudinal hospital based study was conducted at the Outpatient Department of Rheumatology and Psychiatry, Jagadguru Sri Shivarathreeshwara Hospital, Mysuru, Karnataka, India, from January 2018 to June 2019, included 85 consecutive participants with RA were recruited and assessed at baseline with Health Assessment Questionnaire scale {HAQ-DI and Visual Analog Scale (VAS)}, Hamilton Anxiety Scale (HAM-A), and Hamilton Depression Scale (HAM-D). Six session of PEI was done using recreating pleasant memory and the same was practiced at home daily by the patient. All participants were reassessed with the same parameter after three months. Paired sample t-test was done to know the change in the score pre and post test on the score of HAQ-DI and VAS, HAM-A, HAM-D. The value of statistical significance was p-value ≤0.05. Results: The majority of the participants belonged to 40-50 years of age, were married, females, studied to middle school, of low socio-economic status, had a nuclear family. The majority had duration of RA been two to four years, with severe illness and were on regular medication. Statistically significant difference was observed in pre and post test on the score of HAQ-VAS (t=8.23, p<0.05), HAM-A (t=11.40, p<0.05) and HAM-D (t=10.95, p<0.05). Conclusion: Brief psychological intervention (PEI) may be a useful adjunct intervention in patients with RA. Further study is needed to explore the clinical use of the PEI for intervention in RA.