Self-management Of Pain And Influencing Fators In Axial Spondyloarthritis Patients

BackgroundPain is the most common early complaint of axial spondyloarthritis patients,which has a serious impact on the quality of life and work ability of patients.The guidelines recommend that the optimal management requires a combination of non-pharmacological and pharmacological treatment of axSpA patients.Self-management is an important part of pain management.There are differences in pain intensity,disease activity,function,and psychological status among patients,which lead to different effect on pain self-management.Objectives1.To assess pain intensity,disease activity,function,spinal mobility and pain self-efficacy in patients with axSpA;2.To clarify pain self-management status in in patients with axSpA;3.To explore the influencing factors of pain self-management in patients with axSpA.Methods1.ParticipantsA total of 266 patients with axial spondyloarthritis and an average pain score over 1 on a 0?10 numeric rating scale were recruited from one Grade III hospital from July 2016 to December 2018.2.Instruments2.1 Pain assessmentThe Brief Pain Inventory(BPI)scored 0 to 10 was used to assess pain intensity and its interference.2.2 Disease activity,physical function,and spinal mobilityThe Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)was used to assess disease activity in axSpA patients,with a total score of 0-10.The Bath Ankylosing Spondylitis Functional Index(BASFI)was used to assess physical fcunction in axSpA patients,with a total score of 0-10.The Bath Ankylosing Spondylitis Metrology Index(BASMI),finger to floor distance and occiput-to-wall distance were used to assess spinal mobility in axSpA patients.The BASMI scored 0 to 10.2.3 Pain Self-EfficacyThe Pain Self-Efficacy Questionnaire(PSEQ)was used to assess patients',s confidence when manage pain,with a total score of 0 to 60.2.4 Self-management statusThe Chronic Disease Self-Management Study Measures(CDSSIM)include Exercise Behavior scale,Cognitive Symptom Management,and Communication with Physicians.It was used to assess the patient's exercise time,cognitive symptom management scores,and communication with physicians in the past week,with a total score of 0 to 69.The Pain Management Inventory(PrMI)was used to evaluate the total number(0-15),frequency(15-90 points)and effect of pain self-management methods(1-6 points).3.Study proceduresPatients completed questionnaires including pain assessment,disease activity,physical function and self-management behavior.After patients completed the questionnaires,the investigators measured the BASMI,finger to floor distance and occiput-to-wall distance.Clinical information was collected by Electronic Medical Records.Results1.Pain intensity and its interferenceThe median scores of pain intensity and its interference in axSpA patients were 2.3(1.3,3.0)and 2.7(1.3,4.4),respectively.There were 30.8%of the patients who suffered moderate to severe pain,which had a moderate interference on patients5 daily life,mood,work,sleep and life interests,and a slight interference on walking ability and relationship with others.Compared with the patients who had been treated,the newly diagnosed axSpA patients had more severe pain intensity and interference(P<0.05).The axSpA patients with chronic disease had more severe pain intensity and interference(P<0.05).2.Disease activity,physical function and spinal mobilityThe median scores of the BASDAI,the BASF,,and the BASMI were 2.7(1.4,4.0),1.6(0.7,3.1)and 2.2(1.2,3.8),respectively.The median scores of finger to floor distance and occiput-to-wall distance were 11.0(0,24.3)and 0(0,0)cm,respectively.The median duration of morning stiffness was 5.0(0,15.0)minutes.There were 25.6%of axSpA patients at high disease activity.A total of 10.9%patients were severely restricted in physical function,and 20.3%of patients were severely restricted in spinal mobility.The male patients had longer finger to floor distance,longer occiput-to-wall distance and higher BASMI score(P<0.05).The smoking patients and patients who drank had higher BASMI score,longer finger to floor distance and longer sti:ffness time(P<0.05).The smoking patients had longer stiffness time(P<0.05).3.Paim self-efficacyThe axSpA patients had high scores in pain self-efficacy,which the median score was 46(35,55).The stiffness patients,unemployed patients,patients with BASDAI score over 4 and BASFI score over 5 have lower pain efficacy scores(P<0.05).4.Pain self-management statusPain self-management in axSpA patients was at a low level.Patients used an average of 5(3,8)methods to manage pain,with a frequency score of 33.0(25.0,41.0)and with effectiveness score of 1.9(1.5,2.5).The three most commonly used methods of pain management were taking prescribed medicine(77.4%),massage(72.2%),and exercise(65%).The three most effective methods to manage pain were taking prescribed medicine(4 points),exercise(3 points)and hot pool bath(2 points).Exercise was the most effective non-pharmacological method to manage pain for axSpA patients,but 59.8%of patients' exercise time have less than 150 minutes per week.The median scores of cognitive symptom management and communication with physicians were 1.3(0.7,2.0)and 1.7(0.7,2.0),respectively.5.Influencing factorCognitive symptom management score,disease activity,employment situation and total exercise time were the factors influencing pain self-management status(P<0.05).Compared with patients' exercise time less than 150min/week,patients with exercise time more than 150min/week perceived that pain self-management was more effective.Compared with patients who had mild pain,patients with moderate pain used pain self-management methods more frequently,but there was no difference.Compared with patients with BASDAI score under 4,patients with BASDAI over 4 used pain self-management methods more frequently,but there was no difference in their effectiveness.Unemployed patients used pain self-management more frequently than working patients,and they consider that pain self-management was more effective.There was no difference in the frequency and effectiveness of pain self-management between the newly diagnosed patients and the patients who had been treated.Cognitive symptom management score,stiffeness and finger to floor distance were the factors influencing pain self-management status in newly diagnosed axSpA patients.Cognitive symptom management score and disease activity were the factors influencing pain self-management status in axSpA patients who had been treated.ConclusionsAxSpA patients experienced different degree of pain intensity which had different interference.Pain self-management in axSpA patients was at a low level.Cognitive symptom management score,disease activity,employment situation and exercise time were the factors influencing pain self-management status.Exercise was a commonly used and effective way to manage pain,but patients have insufficient exercise.The results provide reference for the establishment of pain self-management programs in axial spondyloarthritis patients.