Background/Purpose: Although it is reported that biological treatment has a positive effect on Rheumatoid arthritis (RA), pain intensity is still moderate to high in the majority of those affected, causing activity limitations and thus participation restrictions. Indeed, persons with RA have identified pain as the predominant health status impairment most important to reduce. However, pain in RA is commonly assessed using a visual analogue scale (VAS), which does not capture the complexity of pain and certainly does not address the management of it in daily activities. The purpose was to describe how persons with RA experience and manage pain in their daily life.

Methods: A focus group study was conducted. The participants were recruited with a purposive sample from three Rheumatology Units in Sweden. The inclusion criteria were seropositive RA, ≥4 years duration and pain intensity >40 mm as reported by VAS over the last two clinical visits. Of 77 eligible patients, 33 agreed to participate (34 to 73 years old). Seven semi-structured focus groups discussions were conducted and analyzed using content analysis. A RA-patient research partner was involved in the study confirming the interview guide and the results from a patient perspective. The study protocol was approved by the Regional Ethical Committee.

Results: The analysis revealed four categories: (1) Pain expresses itself in different ways; referring to descriptions of RA pain as overwhelming, painful and as a feeling of stiffness in joints. While pain was described as closely related to fatigue and stress, sometimes it was invisible to others in the participants’ social environment. (2) Managing by easing the pain; referring to the use of heat and/or cold treatments, medications and activities as distractions. (3) Managing by adapting to pain; referring to the strategies of learning to live with the pain, to plan activities in daily life to reduce pain, to use assistive devices or to sometimes simply stop doing some activities. (4) Managing pain in a social context; referring to the social environment as being both supportive and uncomprehending, the latter causing the participants to sometimes hide their pain.

Conclusion: Pain in RA was described as complex and multifaceted. To manage pain the participants used a wide range of strategies, ranging from personal strategies to those applied in their social context. This wide range of strategies could possibly complement the traditional methods used in clinical settings to manage pain. These findings further suggest that assessment of pain needs to be extended beyond the linear VAS measurement to cover its complexity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/its-like-the-worst-toothache-youve-ever-had-how-persons-with-rheumatoid-arthritis-describe-and-manage-pain-in-daily-life/