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，但大多数患者的病情仍然是慢性的。研究已经证实，人们思考疼痛和疾病的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、专注于症状的人，从长远来看，结果会更差。在类风湿性关节炎中，保持休息和锻炼之间的平衡被认为是至关重要的。因此，忽视疼痛会导致过度活动和随后的关节损伤，可能和活动不足一样没有帮助。这个项目旨在调查人们对疼痛的恐惧和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，那些对疼痛的恐惧程度非常高或非常低的人对疼痛的关注要么过多，要么不足。避免恐惧的最佳水平与减少残疾和改善关节功能有关。这些发现对类风湿关节炎的治疗具有启示意义。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是有效的。治疗通常侧重于改变人们的态度和行为。然而，旨在改变态度或以行为为目标的策略是否更成功或具有特定的治疗效果尚不清楚。目前的项目将比较针对类风湿性关节炎相关行为的治疗，鼓励休息和运动之间的平衡，以及针对患者对疾病的看法的治疗。预计这些治疗将有特定的效果，这可能会更好地根据患者的个人需求定制心理管理。

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.