**3.1 Psychological focus in clinical pain assessment**

Assessment of chronic pain condition for which psychological intervention is required should be characterized by the following;

	- a. Circumstances surrounding the pain; where and when it occurs
	- b. Duration; how long does the pain last at each episode chronic, intermittent or remitting.
	- c. Severity of the pain from the beginning
	- d. Which joint(s) of the body does the pain sensation occur and how often in a day, week, or month.
	- e. What triggers the pain sensation and what makes it better or brings relief
	- f. Use visual analogue scale to rate severity of pain experience at initial clinical assessment. An example is using a scale of 0–10, with zero as no pain and ten as severe pain
	- g. Client's beliefs and thoughts about the pain; is pain seen as unacceptable, a punishment or beyond their control. This relates to pain catastrophizing.
	- h. Client's feelings about and perception of the pain and the circumstances surrounding it. This relates to pain locus of control
	- i. Client's lifestyle and coping strategies being used to cope with the pain; also assess client's activity level
	- j. Client's belief about their ability to control the pain experience. This relates to pain self-efficacy
	- k. Social context and stress level of patient suffering arthritis pain
	- l. Addiction to drugs (including misuse or abuse of prescription drugs for pain management)
	- m. Anxiety disorder
	- n. Sleep disorder
	- o. Depression

There are also evidence-based pain assessment instruments developed to measure various pain related concern like coping and self-efficacy. Some commonly used ones are pain self-efficacy questionnaire, coping strategies questionnaire, brief COPE inventory, and chronic pain coping inventory. The scale a therapist

**77**

*Review of Psychological Interventions in the Management of Arthritic Pain: The Case of Africa*

chooses to use depends on their interest. Generally, the scales are developed to measure behavioral and or cognitive aspects of pain experience or pain coping. A therapist can select a scale if they want to have a more objective assessment of how well a patient uses a particular coping skill when experiencing pain. The following are some coping skills assessed with the scales; diverting attention, reinterpreting pain sensation, guarding, resting, asking for assistance, coping self-statement, ignoring pain, praying and hoping, relaxation, task persistence, exercise, increasing behavioral activities, catastrophizing, stretching and seeking

This will involve clinical decision about required or further investigation to help decide the nature of pain as well as the treatment protocol of choice. Assessment of personality variables, lifestyle, thinking pattern and social network are also important. And the results of biomedical investigations like laboratory, radiological and physical examinations should also be considered. Though arthritis pain is the general concern, psychotherapy should be tailored to suit the personal needs and circumstances of each arthritis patient. Patients, therefore, work with therapists in a collaborative manner during assessment and treatment planning stages, to design the best interventions possible to achieve their treatment goals in the shortest time possible or help them function better with minimal pain and psychological distress.

**3.2 Psychological techniques in treatment or management of pain**

creating new ways to think about it and resolve it.

worsened by other stressors (e.g., work related stress)

D. Psychoeducation about possible psychological symptoms

caregivers and other support network

**3.3 Psychotherapies in arthritis pain management**

F. Hypnosis and Distraction techniques

A. Cognitive restructuring aimed at changing existing beliefs about pain and

B. Relaxation techniques to help deal with anxiety induced by the painful

C. Stress management, this is important as painful conditions can be stressful or

E. Assertiveness skills to help with pain communication between patients, their

Treatment approach can be either group or individual or both as the case may be. Therapy can be as short as 8 sessions; however, the length of psychotherapy depends on the severity of the problem. Common therapies applied to arthritis

a.Cognitive-behavioral therapy: This is used especially when client is presenting with comorbid depression and or anxiety disorder. Techniques used here would address the affect, cognition and behavior of a patient in relation to pain experience. Some applicable techniques are relaxation, cognitive restructuring,

problem solving, *in vivo* desensitization, sleep hygiene, etc., [28].

*DOI: http://dx.doi.org/10.5772/intechopen.93633*

social support [30].

condition

patients include:

*3.1.3 Treatment Planning*

#### *Review of Psychological Interventions in the Management of Arthritic Pain: The Case of Africa DOI: http://dx.doi.org/10.5772/intechopen.93633*

chooses to use depends on their interest. Generally, the scales are developed to measure behavioral and or cognitive aspects of pain experience or pain coping. A therapist can select a scale if they want to have a more objective assessment of how well a patient uses a particular coping skill when experiencing pain. The following are some coping skills assessed with the scales; diverting attention, reinterpreting pain sensation, guarding, resting, asking for assistance, coping self-statement, ignoring pain, praying and hoping, relaxation, task persistence, exercise, increasing behavioral activities, catastrophizing, stretching and seeking social support [30].
