Pain and daily activities in rheumatoid arthritis

Abstract

Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Implications for Rehabilitation

• Pain in RA needs to be comprehensively analyzed and treated in the context of the patients’ perspective and needs.

• The relation between pain and performance of activities in RA highlights the importance of rehabilitative interventions to reduce pain in order to facilitate daily activity.

• The complexity of pain implies the need for multimodal approach in rehabilitation.

Keywords::

• Client perspective
• content analysis
• ICF
• pain
• participation
• rheumatoid arthritis

Acknowledgements

The authors would like to thank the participants, without whom this study would not have been feasible, Birgitta Stenström, Research partner, for valuable comments on the interview questions and in the analysis, AUW Konsult for the verbatim transcripts and MSc. Julie Netto for language editing.

Declaration of Interest: This work was supported by the Swedish Rheumatism Association, with grants from StigThunes Fund, Norrbacka-Eugenia Foundation, FORSS− Research Council of Southeast Sweden and Futurum− The Academy for Healthcare, County Council, Jönköping. No conflict of interest exists.

Appendix 1

Example of meaning units, condensed meaning units, codes, subcategories and categories.

Appendix 2: Focus group interview guide

Opening Question Briefly tell us who you are and shortly summarize your life situation.

Introductory question

• What is pain to you?

Key questions

• How does the pain affect your activities of daily living?

• Do you refrain from activities in daily life because of your pain?

• If you have professional work, what impact has the pain on your working capacity?

• Does your pain affect participation in social contexts?

• How is your occupational balance?

• Do you find a balance between daily activities; for example between work, household chores and relaxation?

• How do you balance your work and leisure activities against each other?

• Can you share with us how your time use is affected by your pain?

• How do you experience pain affecting your roles across different contexts?

• Which environmental factors facilitate or hinder your daily activities?

• What are your strategies to manage pain in daily activities?

• Do you avoid activities in order not to increase your pain?

• When and how do you employ strategies to reduce the pain?

• How does your pain impact on your choices of daily activity?

Short summary by the assistant moderator

Concluding question

Is there anything you would like to add?