Arthritis and Pain Management: Non-Pharmacological Management

Time Required: 
20 minutes

In general, people with arthritis should be advised to maintain an ideal body weight and adhere to a balanced diet containing adequate amounts of protein, fat, vitamins and minerals and if the patient's body mass indexis greater than 30 they should be advised to lose weight [1].

Physical therapy

Many patients still present with functional deficits which physiotherapy seeks to address.

Physiotherapy aims to reduce pain and stiffness, prevent deformity and maximise function, independence and quality of life. Exercise has changed in recent years from passive, isometric exercises to more dynamic forms of exercises that are as consequence of their disease process. Research has demonstrated that RA patients are at a higher risk from cardiovascular disease and osteoporotic fractures than the general population.

Occupational Therapy

Occupational therapy aims to improve a person’s ability to perform daily activities and participate in valued life activities and roles at work, in the home, leisure and socially; facilitate successful adaptations in lifestyle; and to prevent or minimise functional and psychological problems. Comprehensive OT programmes can include a wide range of interventions. Enabling self-management using strategies such as joint protection and fatigue management is a central part of treatment. Enhancing concordance is essential and so OTs with enhanced training frequently offer cognitive-behavioural approaches.

Psychological/cognitive strategies

A patient's thoughts, feelings, emotions and behaviour and his or her family's response can influence the arthritis pain experience [1]. Therefore, education about pain, pain management options and self-management programmes should be communicated to the patient and family as an integral and cost effective part of the treatment (Simon et al 2002). Cognitive behavioural therapy should be used to reduce pain and psychological disability and to enhance self-efficacy and pain coping [1].

Thermal biofeedback either alone or in combination with relaxation training has been shown to be effective in decreasing pain and pain behaviours and increasing functional abilities ([2], [3], [4], [5]).

Acupuncture

The results from acupuncture studies for OA are mixed. Certainly the studies which have shown superiority of acupuncture over placebo have shown this only in the short term (6–12 weeks). At 26 weeks there are few studies, and overall they do not support a benefit over placebo. It therefore seems likely that acupuncture can provide short- to medium-term relief for some people. Acupuncture of peripheral joints appears safe. The question that remains unclear is whether a specific group of people with osteoarthritis, who will particularly benefit from acupuncture, can be identified.

The NICE guidelines for RA [6] conclude that there is little evidence available to inform people with RA who wish to try complementary therapies. Although somemay provide short-term symptomatic benefit, there is little or no evidence for their long-term efficacy. If a person with RA decides to try complementary therapies, they should be advised that:-

  • these approaches should not replace conventional treatment
  • this should not prejudice the attitudes of members of the multidisciplinary team, or affect the care offered.

References

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