Psychological aspects of pain in rheumatoid arthritis: a review.

Pain in rheumatoid arthritis (RA) is reviewed from a socio-cognitive perspective. Questions are raised about the usefulness of the distinction between organic vs non-organic pain patients, and alternative explanations for the behaviour of seronegatives is presented. A case based on physiology and behaviour is made for more studies of the acute and prechronic stages of RA. Four major areas of methodology are considered: studies of lay explanations about RA show that people hold relatively accurate views about the nature of pain in RA, and where causal explanations are given for pain and illness, this is conducive to good mental health. A section on the measurement of pain addresses issues about the applicability and standardisation of scales, and welcomes the move from the exclusive use of quantitative to qualitative multidimensional measures. The pain language of RA is described. Experimental studies of pain in RA appear to be of limited use. A review of activities and functional disability indicates that cognitive and behaviour modification techniques appear to have most promise in motivating chronic patients to be more active, and to comply with medication, as well as improving mental health. In a discussion of successful therapies, the principles of reducing uncertainty and increasing perceptions of control are the underlying features. However the reliability of cognitive therapies in the treatment of RA so far remains unproven.