Avoidance of Activities in Early Symptomatic Knee Osteoarthritis: Results from the CHECK Cohort

Background

Pain-related avoidance of activities is hypothesized to lead to lower muscle strength and thereby activity limitations. Negative affect (e.g., low vitality, depression) is thought to strengthen the tendency to avoid activities.

Purpose

The aim of this study was to assess the validity of this ??avoidance model?? in patients with early symptomatic knee osteoarthritis (OA).

Methods

Cross-sectional data (n?=?151) were used. The associations between pain, negative affect, avoidance, muscle strength, and activity limitations were modeled using structural equation modeling.

Results

Pain and negative affect were associated with lower muscle strength via avoidance (mediation by avoidance). Avoidance was associated with activity limitations via lower muscle strength (mediation by muscle strength). There were also direct associations between pain, negative affect, avoidance, muscle strength, and activity limitations.

Conclusions

The results support the validity of the avoidance model, which explains the associations between pain, negative affect, avoidance, muscle strength, and activity limitations in patients with early symptomatic knee OA.     

Fear-Avoidance,Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain

Background

Prior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability.

Purpose

The aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed.

Methods

The sample was composed of 686 patients with chronic spinal pain. Structural equation modelling analyses were used to test the hypothetical model.

Results

Experiential avoidance was associated with pain fear-avoidance, and resilience was strongly associated with pain acceptance. Pain acceptance was negatively associated with negative mood, functional impairment and pain intensity. However, pain fear-avoidance was positively and significantly associated with negative mood but had no association with pain intensity. There was a path from functional impairment to pain fear-avoidance.

Conclusions

Resilience and experiential avoidance appear as variables which could explain individual differences in pain experience.     

Emotional Modulation of Pain and Spinal Nociception in Persons with Severe Insomnia Symptoms

Background

Impaired sleep enhances pain, perhaps by disrupting pain modulation.

Purpose

Given that emotion modulates pain, the present study examined whether emotional modulation of pain and nociception is impaired in persons with severe insomnia symptoms relative to controls.

Methods

Insomnia group (n?=?12) met the International Classification of Diseases, tenth revision symptoms for primary insomnia and controls (n?=?13) reported no sleep impairment. Participants were shown emotionally evocative pictures (mutilation, neutral, and erotica) during which suprathreshold pain stimuli were delivered to evoke pain and the nociceptive flexion reflex (NFR; physiological correlate of spinal nociception).

Results

Emotional responses to pictures were similar in both groups, except that subjective valence/pleasure ratings were blunted in insomnia. Emotional modulation of pain and NFR was observed in controls, but only emotional modulation of NFR was observed in insomnia.

Conclusions

Consistent with previous findings, pain modulation is disrupted in insomnia, which might promote pain. This may stem from disrupted supraspinal circuits not disrupted brain-to-spinal cord circuits.     

Salivary Cortisol and Cold Pain Sensitivity in Female Twins

Background

There is a dearth of knowledge about the link between cortisol and pain sensitivity.

Purpose

We examined the association of salivary cortisol with indices of cold pain sensitivity in 198 female twins and explored the role of familial confounding.

Methods

Three-day saliva samples were collected for cortisol levels and a cold pressor test was used to collect pain ratings and time to threshold and tolerance. Linear regression modeling with generalized estimating equations examined the overall and within-pair associations.

Results

Lower diurnal variation of cortisol was associated with higher pain ratings at threshold (p?=?0.02) and tolerance (p?<?0.01). The relationship of diurnal variation with pain ratings at threshold and tolerance was minimally influenced by familial factors (i.e., genetics and common environment).

Conclusions

Understanding the genetic and non-genetic mechanisms underlying the link between HPA axis dysregulation and pain sensitivity may help to prevent chronic pain development and maintenance.     

Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain

Background

Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined.

Purpose

This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes.

Methods

A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21–77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol.

Results

Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = ?2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = ?4.11, p < .001), particularly for African Americans.

Conclusions

This study underscores the importance of examining the contribution of psychological and behavioral factors when addressing racial differences in pain processing. Additionally, it lends support for the deleterious impact of depressive symptoms on sleep efficiency, suggesting that both sequentially mediate racial differences in endogenous pain facilitation.

     

Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients

Background

Prior studies found that pain fear avoidance and pain acceptance are significantly associated with adjustment to chronic pain.

Purpose

The purpose of this study is to compare the influence of pain fear avoidance and pain acceptance on adjustment to chronic pain across three samples: patients with chronic back pain treated at primary care centres, patients with heterogeneous pain conditions treated at a pain clinic and patients with pain associated with inflammatory bowel disease.

Methods

Structural equation modelling was used to test for differences between groups in the linear relationships between variables.

Results

The model had the best fit for the group of patients with back pain. Three significant relationships were equal across the groups: experiential avoidance on pain fear avoidance, pain intensity on pain fear avoidance, and pain fear avoidance on negative mood.

Conclusions

The associations between both pain fear avoidance and pain acceptance and adjustment to chronic pain vary depending on the pain condition and the type of health care centres where the patients are treated.     

Stress-Related Clinical Pain and Mood in Women with Chronic Pain: Moderating Effects of Depression and Positive Mood Induction

Background

Chronic pain with comorbid depression is characterized by poor mood regulation and stress-related pain.

Purpose

This study aims to compare depressed and non-depressed pain patients in mood and pain stress reactivity and recovery, and test whether a post-stress positive mood induction moderates pain recovery.

Methods

Women with fibromyalgia and/or osteoarthritis (N?=?110) underwent interpersonal stress and were then randomly assigned by pain condition and depression status, assessed via the Center for Epidemiological Studies-Depression scale, to positive versus neutral mood induction.

Results

Depression did not predict stress-related reactivity in despondency, joviality, or clinical pain. However, depression × mood condition predicted recovery in joviality and clinical pain; depressed women recovered only in the positive mood condition, whereas non-depressed women recovered in both mood conditions.

Conclusions

Depression does not alter pain and mood stress reactivity, but does impair recovery. Boosting post-stress jovial mood ameliorates pain recovery deficits in depressed patients, a finding relevant to chronic pain interventions.     

Pain processing in atypical Parkinsonisms and Parkinson disease: A comparative neurophysiological study

Objective

Pain is a frequent non-motor feature in Parkinsonism but mechanistic data on the alteration of pain processing are insufficient to understand the possible causes and to define specifically-targeted treatments.

Validation of the Orbach & Mikulincer Mental Pain Scale (OMMP) on a drug addicted population

Purpose

Recognizing the relevance of mental pain in drug addiction, this study aimed to adapt and validate the Portuguese translation of the Orbach & Mikulincer Mental Pain Scale (OMMP) on a drug addicted population and assess its psychometric properties.

Methods

The study sample (N = 403) was collected from several outpatient treatment centres for drug addiction and in therapeutic communities located in the north of Portugal. The validation of the OMMP Scale followed the same method considered by the authors of the original scale.

Results

A confirmatory factor analysis (CFA) was performed and did not confirm the structure of eight factors provided by the authors. An exploratory factor analysis revealed a five-factor model (labeled emptiness, irreversibility, emotional flooding, helplessness and confusion) leading to a reduction from 40 to 24 items. The OMMP-24-P showed acceptable levels for internal consistency and test–retest reliability. Confirmatory factor analysis indices supported the five-factor model. OMMP-24-P factors were positively correlated with measures of stress, anxiety and depression, negatively associated with quality of life, and showed small to moderate positive correlations with drug addiction severity, with exception of the helplessness factor.

Conclusions

This study has shown the OMMP-24-P to be a valid and reliable scale for assessment and evaluation of mental pain among drug addicts. Further research should attempt to determine the contribution that mental pain can provide towards an understanding of drug addiction dynamics and other psychopathological syndromes, and thereby contribute to the development of more effective treatment programs.     

Pain as the only symptom of cervical artery dissection

Background

Headache or neck pain is a frequent symptom of spontaneous cervical artery dissection (sCAD).

Patients and methods

Patients were drawn from an ongoing hospital‐based registry of consecutive cases diagnosed with sCAD. Only patients with isolated pain were included in this series. Pain topography, dynamics, severity and quality, imaging findings and outcome were analysed.

Results

20 of 245 (8%) patients with sCAD presented with pain as the only symptom (mean (SD) age 39 (8) years; 14 (70%) women). Of them, 12 had vertebral artery dissection, 3 had internal carotid dissection and 5 had multiple dissections. The median delay from symptom onset to diagnosis was 7 days (range 4 h to 29 days). 6 patients presented with headache, 2 with neck pain and 12 with both. Onset of headache was progressive in 6, acute in 8 and thunderclap‐type in 4 patients; neck pain was progressive in 7 and acute in 7. Headache was throbbing in 13 and constrictive in 5 patients; neck pain was throbbing in 4 and constrictive in 10. Pain was unilateral in 11 and bilateral in 9. Pain was different from earlier episodes in all but one case. All patients were pain free at 3 months.

Conclusion

Pain may be the only symptom in sCAD, even when multiple arteries are dissected. Pain topography, dynamics, quality and intensity were heterogeneous. Data from this study lend support to recommendations favouring imaging studies of the cervical arteries in patients with new‐onset unexplained headache or neck pain.Spontaneous cervical artery dissection (sCAD) is a well‐recognised cause of stroke, particularly in the young, with a wide spectrum of clinical presentations.^1,2 Patients may present with local manifestations, ischaemic signs or both. The typical clinical manifestations of spontaneous vertebral artery dissections (sVADs) are thought to be occipital headache, posterior neck pain or both, as well as posterior circulation ischaemia or subarachnoid haemorrhage (SAH).^3,4,5 Patients with spontaneous internal carotid artery dissection (sICAD) mainly present with ipsilateral anterior headache or neck pain, Horner''s syndrome, cranial nerve palsies and retinal or cerebral ischaemia.^2,6Pain is the most frequent local symptom and often the initial manifestation of sCAD. However, it has rarely been reported as the only symptom of sCAD.^{7,8,9,10,11,12} Therefore, to determine patterns of pain that could raise suspicion about sCAD, we analysed patients with sCAD, who presented with only headache or neck pain.     

Detecting panic disorder in emergency department chest pain patients: A validated model to improve recognition

Objective

To develop and validate a detection model to improve the probability of recognizing panic disorder in patients consulting the emergency department for chest pain.

Methods

Through logistic regression analysis, demographic, self-report psychological, and pain variables were explored as factors predictive of the presence of panic disorder in 180 consecutive patients consulting an emergency department with a chief complaint of chest pain. The detection model was then prospectively validated on a sample of 212 patients recruited following the same proceduce.

Results

Panic-agoraphobia (Agoraphobia Cognitions Questionnaire, Mobility Inventory for Agoraphobia), chest pain quality (Short Form McGill Pain Questionnaire), pain loci, and gender variables were the best predictors of the presence of panic disorder. These variables correctly classified 84% of chest pain subjects in panic and non-panic disorder categories. Model properties: sensitivity 59%; specificity 93%; positive predictive power 75%; negative predictive power 87% at a panic disorder sample prevalence of 26%. The model correctly classified 73% of subjects in the validation phase.

Conclusion

The scales in this model take approximately ten minutes to complete and score. It may improve upon current physician recognition of panic disorder in patients consulting for chest pain.     

Computer-Delivered Social Norm Message Increases Pain Tolerance

Background

Few experimental studies have been conducted on social determinants of pain tolerance.

Purpose

This study tests a brief, computer-delivered social norm message for increasing pain tolerance.

Methods

Healthy young adults (N?=?260; 44 % Caucasian; 27 % Hispanic) were randomly assigned into a 2 (social norm)?×?2 (challenge) cold pressor study, stratified by gender. They received standard instructions or standard instructions plus a message that contained artifically elevated information about typical performance of others.

Results

Those receiving a social norm message displayed significantly higher pain tolerance, F(1, 255)?=?26.95, p?<?.001, η _p ² ?=?.10 and pain threshold F(1, 244)?=?9.81, p?=?.002, η _p ² ?=?.04, but comparable pain intensity, p?>?.05. There were no interactions between condition and gender on any outcome variables, p?>?.05.

Conclusions

Social norms can significantly increase pain tolerance, even with a brief verbal message delivered by a video.     

Endogenous Inhibition of the Nociceptive Flexion Reflex (NFR) and Pain Ratings During the Menstrual Cycle in Healthy Women

Background

The menstrual cycle influences pain, with symptoms often increasing during the premenstrual (late-luteal) phase. Deficiencies in endogenous inhibition of afferent nociception at the spinal level might contribute to menstrual phase-related changes in pain.

Purpose

This study assessed whether conditioned pain modulation (CPM) of spinal nociception differs between mid-follicular and late-luteal phases.

Methods

CPM was evoked by a blood pressure cuff affixed to the right forearm and inflated to induce ischemia in 41 healthy women during both menstrual phases. Suprathreshold electric stimuli were delivered to the left sural nerve to evoke pain and the nociceptive flexion reflex (NFR) before, during, and after forearm ischemia.

Results

Forearm ischemia produced CPM of electrocutaneous pain and NFR, but inhibition did not differ across mid-follicular and late-luteal phases.

Conclusions

Mechanisms contributing to changes in experimental pain across mid-follicular and late-luteal phases in healthy women are not due to deficits in CPM of spinal nociception.     

Complex regional pain syndrome,alexithymia, and psychological distress

Objective

This study aims to elucidate the relationships between alexithymia, psychological distress, and pain in persons with complex regional pain syndrome (CRPS).

Methods

Participants were 60 Israeli adults ages 19–65. This is a cross sectional study with a comparison group. Alexithymia, psychological distress, and pain were assessed in 30 individuals with CRPS in comparison to 30 gender- and age-matched persons with lower back pain (LBP). Assessments included the Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and two subscales of the McGill Pain Questionnaire.

Results

Persons with CRPS had significantly higher ratings of psychological distress and of alexithymia when compared to LBP controls. Pain severity was significantly associated with higher levels of alexithymia and psychological distress among persons with CRPS, but not among controls. Alexithymia and pain severity correlations were significantly different between the two groups. In persons with CRPS, the relationships between alexithymia and pain severity and between difficulty identifying feelings and pain were not confounded by psychological distress.

Conclusions

To our knowledge, this is the first cross sectional study providing empirical evidence on the relationship between alexithymia and CRPS. From the perspective of conceptualizing alexithymia as an outcome of CRPS, findings highlight the importance of early CRPS diagnosis and support the provision of care that addresses pain-related psychological distress and alexithymia among CRPS patients. Also, findings underscore the need to generate alternative, non-physical avenues, such as learning to identify feelings for processing pain, in order to reduce pain among persons with CRPS.     

Identifying neuropathic pain in patients with multiple sclerosis: a cross-sectional multicenter study using highly specific criteria

Background

Pain is a common and heterogeneous complication of multiple sclerosis (MS). In this multicenter, cross sectional study, we aimed at investigating the prevalence of pain in MS using highly specific criteria for distinguishing the different types of pain.

Materials and methods

After a structured interview, in patients with pain, clinical examination and DN4 questionnaire were used for distinguishing neuropathic and nociceptive pain. In subjects with neuropathic pain, the Neuropathic Pain Symptom Inventory was used for differentiating neuropathic pain symptoms.

Results

We enrolled 1249 participants (832 F, 417 M, mean age 33.9 years, mean disease duration 8 years, mean EDSS 3.2); based on clinical evaluation and DN4 score 429 patients (34.34%) were classified with pain (470 pain syndromes): 286 nociceptive pain syndromes and 184 neuropathic pain syndromes. Multivariate analysis showed that pain was associated with age, gender and disease severity and that neuropathic pain was distinctly associated with EDSS.

Conclusions

Our study, providing definite information on the prevalence, characteristics and variables associated with neuropathic pain due to MS, shows that a more severe disease course is associated with a higher risk of neuropathic pain. Our findings might, therefore, provide a basis for improving the clinical management of this common MS complication.

     

Risk Factors for Suicidal Ideation among Patients with Complex Regional Pain Syndrome

Objective

Chronic pain frequently coexists with psychiatric symptoms in patients diagnosed with complex regional pain syndrome (CRPS). Previous studies have shown a relationship between CRPS and the risk of suicide. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS.

Methods

Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD), and symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I, SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI).

Results

Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p=0.002), severity of pain (p=0.024), and low scores on the GAF (p=0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep.

Conclusion

Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.     

Pain and motor complications in Parkinson's disease

Aims

To study the association of pain with motor complications in 117 patients with Parkinson''s disease.

Methods

Patients were asked to refer any pain they experienced at the time of study and lasting since at least 2 months. Basic parkinsonian signs and motor complications (including motor fluctuations and dyskinesia) were assessed and Unified Parkinson''s Disease Rating Scale (UPDRS) motor score part III (during on) and part IV were calculated. Information on age, sex, duration of disease, use of dopamine agonists and levodopa, years of levodopa treatment and current levodopa dosage, medical conditions possibly associated with pain, and depression were collected. Single and multiple explanatory variable logistic regression models were used to check the association of pain with the investigated variables.

Results

Pain was described by 47 patients (40%) and could be classified into dystonic (n.19) and non dystonic pain (n.16); in 12 patients both types coexisted. Multiple explanatory variable logistic regression models indicated a significant association of pain with motor complications (adjusted OR, 5.7; 95% CI, 2 to 16.5; p = 0.001). No association was found between pain, dystonic or non dystonic, and the other investigated variables including medical conditions known to be associated to pain in the general population. There was a significant correlation (r = 0.31, p<0.05) between severity of pain (measured on a Visual Analogue Scale) and severity of motor complications (UPDRS part IV).

Conclusions

Pain may be a representative feature of Parkinson''s disease frequently associated with motor complications. The association is independent of a number of potentially relevant demographic and clinical variables.Several patients with Parkinson''s disease complain of painful sensations that can be described in different categories.^{1,2,3,4,5,6,7} These include dystonic spasm‐associated pain and non‐dystonic pain such as musculoskeletal or rheumatic pain, neuritic or radicular pain, primary or central pain, and akathitic discomfort.^8,9 The suggested involvement of basal ganglia in the modulation of somatosensory function is thought to account for pain in Parkinson''s disease.¹⁰ Nevertheless, the response of pain to levodopa is uncertain: whereas some studies reported that treatment for Parkinson''s disease was sometimes effective in relieving pain in patients with Parkinson''s disease,^4,5 other studies failed to find any correlation between motor symptoms, drugs against Parkinson''s disease and pain.^11,12 In some cases, dopaminergic drugs even aggravated pain.⁴Those designing strategies to prevent or cure pain in patients with Parkinson''s disease should consider the possible pathogenetic mechanisms and potential risk factors. The few studies considering these issues described a higher frequency of fluctuations in motor function and end or peak of dose dyskinesia among patients with Parkinson''s disease experiencing pain, and suggested a relationship between some pain categories and motor complications.^5,7In this study, we evaluated the association of pain with motor complications, taking into account possible confounding by demographic and clinical variables related to Parkinson''s disease and medical conditions associated with painful symptoms.     

Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects

Background

Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day.

Purpose

This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations.

Methods

Chronic low back pain patients (n = 105) completed structured electronic diary assessments five times per day for 14 days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing.

Results

Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality × time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant.

Conclusions

Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night’s sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.

     

Transient Amnesia After Coiling of a Posterior Circulation Aneurysm

Background

Acute amnesia can be caused by medication effect, transient global amnesia, ischemia, metabolic abnormalities, and seizures.

Methods

Case report.

Results

A 56-year-old woman developed acute amnesia resembling transient global amnesia (TGA) after aneurysm coiling. She was started on abciximab for possible thromboembolic complications related to coiling. Abciximab was discontinued after she developed chest pain. Her chest pain resolved after discontinuing abciximab. She was subsequently found to have small medial temporal lobe strokes on diffusion weighted MRI.

Conclusions

Ischemia in the posterior circulation should be considered in the differential diagnosis of TGA, especially in situations predisposing to thromboembolism such as coiling.     

Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health

Background

In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.

Purpose

The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.

Methods

Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N?=?152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models.

Results

Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year.

Conclusions

Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health.