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The Challenges of Adjusting to Osteoarthritis
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Posted on: 10/23/2008
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A diagnosis of osteoarthritis (OA) affects both the patient and his or her partner or spouse. Both individuals face a number of challenges in adjusting to someone in the relationship having chronic, disabling pain.
In this study, self-efficacy for communication about pain for the patient and strain for the spouse is measured. Self-efficacy refers to the person's confidence to do a specific task, communicate a particular idea, or achieve certain goals. The effect of holding back in discussions about the effect of pain and arthritis-related problems on the relationship was measured.
Patients (and their spouses) included in the study had knee osteoarthritis and attended the Rheumatology Clinic at Duke Medical Center in North Carolina. They all agreed to complete several surveys designed to measure self-efficacy in communication.
Measures used included Lorig's Scale of Self-Efficacy, Pistrang and Barker's questionnaire, the Arthritis Impact Measurement Scale (AIMS), Pain Catastrophizing Scale, the Positive and Negative Affect Schedule (PANAS), and the Caregiver Strain Index (CSI).
Each one of these tools measured various aspects of pain, psychologic distress, disability, mood, tendencies to catastrophize (exaggerate pain), and health status. For example, the Scale of Self-Efficacy for pain communication asked about patients' confidence in telling their partner about their pain. Questions asked included, How certain are you that you can let your partner know how much your pain is bothering you? Or, How certain are you that your partner will respond to your pain in a way that meets your needs?
The questionnaire measuring how much patients and partners hold back in talking about pain-related concerns included 11 areas of interest. Feelings and concerns were measured in relation to pain, other symptoms, body image, fears and emotions, finances, and relationships with family and friends.
The Arthritis Impact Measurement Scale (AIMS) took a look at pain and disability (psychologic and physical disability). Anxiety and depression were measures of psychologic disability. Physical activity (including activities of daily living), movement and mobility, and manual dexterity were assessed when making a determination about physical disability.
The Pain Catastrophizing Scale was used to indicate how often and how much patients' dwelled on their pain. It was a measure of symptom magnification and feelings of helplessness. At the same time, the partner's mood (positive or negative) was measured.
The researchers compared self-efficacy with all of these measures looking for correlation or links between different variables. They found that both groups (patients and partners) scored low on self-efficacy. This means they both felt low in their confidence to talk about their adjustment to the patient's pain and disability. Patients seemed to be able to communicate better than their partners in this regard.
Even though they doubted their own confidence in this area, both groups did not hold back from discussing their concerns with each other. Patients did tend to hold back more than their partners. When they held back, their levels of pain catastrophizing and psychologic distress increased. When the partner held back, their level of strain as a caregiver went up dramatically. And, when the partner held back, the patient experienced greater psychologic distress.
A vicious cycle was present: the lower the patient and partners' self-efficacy (confidence in communication), the more they held back in talking about their concerns. The lower their self-efficacy and the more patients held back, the greater their pain catastrophizing and psychologic distress became.
Adjusting to a chronic and painful condition like osteoarthritis requires communication on the part of both patient and partner. The patient who can explain their pain well enough for the partner to understand seems to adjust better with lower levels of pain and disability. The adjustment goes even more smoothly when the caregiver is confident in his or her ability to manage the challenge of pain communication and strain in the relationship.
The authors suggest both partners might benefit from treatment aimed at improving communication. Training could help each one find ways to share thoughts and feelings in a non-threatening manner. Setting up shared goals and assisting each partner in responding to the other may help smooth out the adjustment phase. Improving confidence and skills in pain communication may reduce negative outcomes for both patient and partner.
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References:
Laura S. Porter, PhD, et al. Pain Communication in the Context of Osteoarthritis Patient and Partner Self-Efficacy for Pain Communication and Holding Back from Discussion of Pain and Arthritis-Related Concerns. In The Clinical Journal of Pain. October 2008. Vol. 24. No. 8. Pp. 662-668.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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