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Positive psychological interventions ineffective for OA pain
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Positive psychological interventions were ineffective as a stand-alone treatment for pain among black and white veterans with knee osteoarthritis, according to findings published in JAMA Open Network.
“This study is the largest clinical trial, to date, testing the effects of positive psychological interventions in a population recruited from clinical settings,” Leslie R.M. Hausmann, PhD, of the U.S. Department of Veterans Affairs Pittsburgh Healthcare System, told Healio Rheumatology. “Most studies that have been published on this topic have been smaller. Our study population is unique, in that it includes military veterans with substantial pain and functional impairment from knee osteoarthritis. The sample is also predominantly male and includes African American and white veterans.”
To analyze the effects of a positive psychological intervention on pain and functional difficulty among veterans with knee OA, the researchers established the Staying Positive with Arthritis Study, a large, double-blinded randomized clinical trial at two VA medical centers, in Pittsburgh and Philadelphia. Participants included 360 non-Hispanic white and non-Hispanic black patients with OA aged 50 years or older, recruited through mail and telephone from July 8, 2015, to Feb. 1, 2017. Following enrollment, participants were randomly selected to receive the positive psychological intervention or the control program.
The intervention group participated in a 6-week series of activities, administered through a workbook or over the telephone with an interventionist, including recalling and reflecting on positive events, writing a letter of gratitude, cultivating mindfulness, practicing kindness and engaging in practices that they enjoy or provide a sense of achievement. The control program was identical to the intervention in terms of framing, format, duration and delivery, but included neutral, rather than positive, activities. These included recalling events that affected the participant each day, identifying ways to change their life circumstances, remembering early memories, planning their day and recording their weekly activities.
The primary outcomes were self-reported pain and functional difficulty based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The secondary outcomes were affect balance and life satisfaction.
According to the researchers, the mean baseline WOMAC scores were 48.8 (SD = 17.6) for pain and 46.8 (SD = 18.1) for functional difficulty. Although both decreased significantly over time (P <.001 for both), the changes were small and did not vary by group or race. In addition, exploratory analyses indicated that the intervention had counterintuitive effects on secondary outcomes.
“Our study suggests that a telephone-based positive psychological intervention is not effective at reducing pain symptoms or improving well-being in older military veterans with knee arthritis,” Hausmann said. “That said, future work should explore whether such interventions bring added benefit when used in conjunction with other established pain management approaches.” – by Jason Laday
Disclosure: Hausmann reports grant funding from the U.S. Department of Veterans Affairs. Please see the study for all other authors’ relevant financial disclosures.
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Hausmann LRM, et al. JAMA Network Open. 2018;doi:10.1001/jamanetworkopen.2018.2533.
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