Chronic Pain

Mindfulness Training May Help Arthritis Patients Cope

TUESDAY, Dec. 20 -- A small study finds that mindfulness training, which teaches people to push away troublesome thoughts, helped improve well-being in people with rheumatoid arthritis and similar diseases.

Patients in Norway who received the training didn't have less pain compared to those who didn't receive the training, but researchers found they coped better, were less tired and showed less stress.

"Yes, they still have pain, but they are able to manage their pain in more constructive ways," said study author Heidi Zangi, a graduate student at the National Resource Center for Rehabilitation in Rheumatology at Diakonhjemmet Hospital in Oslo.

Mindfulness training teaches people to "stay in the here and now," explained Stefan G. Hofmann, a professor of psychology at Boston University. "It keeps people in the present moment. The instructions are often to focus on breathing or present-moment awareness. As thoughts come into the mind, you just let them come and go without hanging on to them, without focusing on the future, without ruminating about the past."

Mindfulness isn't meditation, but the two are linked, Hofmann said, since "it's impossible to do meditation without doing mindfulness."

Zangi said there's only been limited research into how mindfulness affects people's abilities to cope with pain.

In the new study, researchers recruited 73 people aged 20 to 70 who suffered from inflammatory rheumatic joint diseases such as rheumatoid arthritis.

Some participants took part in 10 group sessions, each 4.5 hours, that focused on teaching mindfulness; they got a booster session after six months. "Through exercises such as guided imagery, drawing, moving to music and use of poetry, participants are invited to process and express their emotions, releasing the energy that has been used to avoid or suppress them," Zangi said.

The other participants were given compact discs with training about mindfulness, but it was up to them to decide whether they would listen to them.

After a year, the researchers followed-up with 67 of the participants to see how they were doing.

The study, published in the Dec. 20 online edition of the Annals of the Rheumatic Diseases, found that those who took part in the in-person training reported better coping and overall well-being than the others.

Kendrin Sonneville, a clinical nutrition specialist at Children's Hospital, Boston, who's studying mindfulness and eating, said the study is strong. It adds to previous research that suggests mindfulness is most effective for mental disorders, such as depression, anxiety, substance abuse and binge-eating disorder, plus pain syndromes and musculoskeletal diseases, Sonneville said.

Hofmann said one next step is to better understand how mindfulness takes people's minds off their pain. It might be a matter of distraction, he said, or general relaxation.

SOURCES: Heidi A. Zangi, graduate student, National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo; Stefan G. Hofmann, Ph.D., professor, psychology, Boston University; Kendrin Sonneville, Sc.D., clinical nutrition specialist, Children's Hospital, Boston; Dec. 20, 2011, Annals of the Rheumatic Diseases, online

MONDAY, Dec. 19 -- Knee pain is common in middle-aged and older women, a new study finds.

Researchers analyzed 12 years of data collected from nearly 500 women, ages 44 to 57, in Britain and found that 63 percent of those 50 and older reported persistent, incident or intermittent knee pain.

Forty-four percent of the women said they had experienced "any pain" and 23 percent said they had knee pain on most days of the previous month. Among those with "any pain" or "pain on most days," 9 percent and 2 percent had persistent pain; 24 percent and 16 percent had incident pain, and 29 percent and 18 percent had intermittent pain, respectively.

Higher body mass index, previous knee injury and radiographic osteoarthritis (OA) -- joint deterioration visible through imaging -- were predictors for persistent pain, the researchers found. Knee injury was also a predictor for intermittent pain.

The study was published Dec. 19 in the journal Arthritis & Rheumatism.

"Our study is the first community-based investigation of knee pain patterns using multiple assessment points over a 12-year period," lead author Dr. Nigel Arden, a professor of rheumatology at the University of Oxford, said in a journal news release.

"Understanding the prevalence and predictors of knee pain is the first step in developing comprehensive pain assessment plans that could lead to more targeted treatment options for those burdened by OA," he added.

Osteoarthritis, a leading cause of disability worldwide, affects more than 27 million Americans over age 25, according to the American College of Rheumatology.

-- Robert Preidt

SOURCE: Arthritis & Rheumatism, news release, Dec. 19, 2011

-- Psoriatic arthritis is an inflammatory joint condition that is associated with the chronic skin condition psoriasis.

The Arthritis Foundation says common symptoms of psoriatic arthritis include:

Joints that are swollen and painful.
Pain and soreness where tendons attach to bone, such as at the heel.
Pitting or separation of nails from the nail bed.
Back pain.
Conjunctivitis, characterized by redness and pain in tissues surrounding the eyes.
Feeling fatigued, reduced range of motion in the joints and feeling stiff in the morning.

MONDAY, Nov. 28 -- Patients who receive artificial joints made with titanium may develop painful inflammation that could destroy bone and loosen the new joint, according to a new study of mice published by the Journal of Immunology.

Contrary to previous studies that blamed bacteria for the inflammation, researchers at the University of Medicine and Dentistry of New Jersey reported that tiny titanium particles that flake off the artificial joints through normal wear and tear may be the cause of the inflammation.

The type of inflammatory response triggered, known as a Th2 response, is more commonly associated with allergic responses and parasitic worm infections, the researchers said in a university news release. The titanium particles, which were seen an invading parasites or allergens, resulted in the generation of immune cells called "alternatively activated macrophages" in the mice.

The release noted although the potential effects of inflammation in the joint are not entirely clear, there is increasing evidence that alternatively activated macrophages contribute to bone destruction in patients who receive prostheses and in those with certain forms of arthritis.

-- Mary Elizabeth Dallas

SOURCE: University of Medicine and Dentistry of New Jersey, news release, Nov. 21, 2011