The ultimate goal of this research is to develop better ways to evaluate and treat pain experienced by rheumatoid arthritis (RA) patients who have persistent pain following joint replacement surgery. The proposed examine behavioral and cognitive coping strategies using by RA patients who have knee pain following knee replacement surgery. Two studies are proposed. In Study 1, we will carry out a comprehensive evaluation of pain and function in 120 RA patients who have intermittent or remittent knee pain at the time of their one year evaluation following pain coping strategies that these RA patients use, and 2) to determine the extent to which pain coping strategies predict pain and function above and beyond effects due to important demographic and medical status variables. Study 2 evaluates the efficacy of a cognitive-behavioral intervention to improve patients' pain coping skills. The intervention will be based on information gathered in Study 1 will be designed to enhance patients' use of adaptive coping strategies and decrease their use of maladaptive coping strategies. Sixty patients have knee pain one year following knee replacment surgery will be randomly assigned to one of three conditions: pain coping skills training, supportive therapy, or standard care. Subjects in the pain coping skills training condition will receive 8, 45-minute sessions designed to teach them how to use cognitive and behavioral techniques to control pain. Subjects in the supportive therapy condition will receive 8, 45-minute individual sessions in which they will be encouraged to explore and discuss issues associated with arthritis, but not instructed in how to alter their coping behaviors. Standard care patients will receive routine care. Data analysis will be carried out: 1) to compare the efficacy of pain coping skills training to supportive therapy and standard care on both a short-term (8 weeks) and long-term (6 months) basis, and 2) to analyze the relationship of changes in pain coping strategies to improvements in pain and function. The long-term benefit of this research is that it may provide RA patients with more effective means of coping with intermittent or remittent pain following joint replacement surgery. The method of assessing pain coping strategies may identifying using maladaptive coping strategies who are in need of specific and timely interventions to prevent adverse behavioral reactions to pain from becoming entrenched.
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