Selective attention and fear avoidance in the maintenance and management of pain associated with rheumatoid arthritis

尽管类风湿性关节炎的治疗取得了进展，但对大多数患者来说，这种情况仍然是一个慢性病程。研究证实，人们对疼痛和疾病的思考方式会影响他们对症状的反应。反过来，这些因素会影响生活质量和残疾。对于有慢性疼痛问题的人来说，那些害怕疼痛并专注于症状的人从长期来看结果更差。在RA中，在休息和锻炼之间取得平衡被认为是至关重要的。因此，忽视疼痛可能会导致过度活动和随后的关节损伤，可能与活动不足一样无济于事。这个项目旨在调查人们对疼痛的恐惧与他们对疼痛的关注程度之间的关系。研究表明，与健康对照组和中度恐惧的患者相比，那些对疼痛具有非常高或非常低水平的恐惧的人要么会过度关注疼痛，要么会对疼痛关注不足。最佳的恐惧回避水平预计与较少的残疾和改善的关节功能有关。这些发现对类风湿关节炎的治疗有一定的指导意义。对类风湿性关节炎患者的心理治疗已被发现在减轻疼痛、残疾和改善情绪方面有效。治疗通常侧重于改变人们的态度和行为的组合。然而，无论是旨在改变态度的策略还是以行为为目标的策略更成功，或者具有特定的治疗效果，都是未知的。本项目将比较针对与类风湿关节炎相关的行为并鼓励在休息和运动之间保持平衡的治疗与针对患者对疾病的信念的治疗。预计这些治疗将产生特定的效果，这可能会更好地根据患者的个人需求进行心理管理。

Despite advances in the treatment of RA, the condition continues to have a chronic course for the majority of patients. Research has established that the way in which people think about pain and illness influences their responses to symptoms. In turn, these factors can impinge on quality of life and disability. For people with chronic pain problems, those who are fearful of pain and concentrate on symptoms have a poorer outcome in the long-term. In RA, striking a balance between rest and exercise is thought to be crucial. As such, ignoring the pain can lead to overactivity and subsequent joint damage and may be as unhelpful as underactivity. This project aims to investigate the relationship between people's fear of pain and the degree to which they attend to pain. It is suggested that those with very high or very low levels of fear towards the pain will either over-attend or under-attend to pain in comparison to healthy controls and patients with a moderate level of fear. Optimum levels of fear avoidance are expected to be associated with less disability and improved joint function. These findings have implications for the management of RA. Psychological treatments for patients with RA have been found to be effective in reducing pain, disability and improving mood. Treatments usually focus on a combination of changing people's attitudes and behaviours. However, whether strategies that aim to change attitudes or those targeting behaviour are more successful or have specific treatment effects is unknown. The present project will compare a treatment targeting behaviours associated with RA and encouraging a balanace between rest and exercise, with a treatment targeting patient's beliefs about the illness. It is expected that the treatments will have specific effects, which may better allow tailoring of psychological management to patient's individual needs.