Evaluation of Cognitive Behavioral Therapy for Long-term Pain in Rheumatic Disease, Including Validation the Questionnaire of AE-FS

Background for the project Up to 30% of the adult population in Norway state that they have had long-term pain . Long-term pain in the musculoskeletal system accounts for 50% of disability cases and is the most frequent cause of long-term absence. This group includes rheumatic disease, back and neck disorders, pelvic pain and shoulder problems. Rheumatic disease is a collective term for over 200 different diseases that are divided into inflammatory rheumatic disease (arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases and vasculitis), degenerative diseases (arthrosis) and soft tissue rheumatism (fibromyalgia). Fibromyalgia is characterized by widespread and long-lasting muscle pain and occurs in about 5% of the population.

The pain picture in rheumatic disease is complex with different pain mechanisms and frequent comorbidity with sleep difficulties, fatigue and psychological problems. The pain can be linked to inflammation and to structural changes, but also to changes in the central nervous system.

With support from Stiftelsen Dam, the Unit for mental health services in somatics and the Unit for research and innovation at the Adult Psychiatric Department Vinderen and the Clinic for Rheumatology, Outpatient Clinic and Research, Diakonhjemmet Hospital, have developed an intervention based on clinical health psychology and cognitive behavioral therapy. The target group is primarily patients with long-term pain and rheumatic disease. The treatment is described in a chapter in the Handbook of Clinical Health Psychology .

A workbook for pain has been developed, following revisions and feedback from 15 individual patients and participants in 2 treatment groups (one physical and one digital) who have followed the scheme. The workbook contains knowledge about pain and pain management, describes measures and homework from session to session. The treatment offered in the project spans 8 sessions of 2 hours each and is carried out either digitally or by physical attendance. A corresponding manual has also been developed for individual treatment over approx. 10 sessions of 45 minutes. The patients are called in for a follow-up appointment 2 months after the ordinary termination.

Negative thought and reaction and behavior patterns in long-term pain Catastrophic thinking is an inappropriate coping style where one overestimates the threat of pain, ponders the causes and is worried about the consequences. In arthritis, catastrophic thinking predicts more intense pain and severe depression symptoms and poorer physical function . In knee osteoarthritis, catastrophizing predicts a longer postoperative course in hospital, and more avoidance of physical activity .