Pharmacological and Non-Pharmacological Interventions for Pain Management in Rheumatoid Arthritis Patients

Running head: PICO QUESTION
PICO Question
Name of the Student
Name of the University
Author Note

1
PICO QUESTION
Patient/Problem
Adult population with rheumatoid arthritis for <= 5 years and age bar in between 30 to 60
years.
Intervention
Medication (DMARDS) and exercise
Exercise: Planning for the physical exercise for 6 months of individualized aerobic exercise
training along with resistance high intensity exercise training for three times per week. This
will be followed by Upper Extremity Exercise Training.
Physical exercise training will be given by a trained physiotherapist and physical training
expert under active supervision of the nursing professional. Medication management will be
controlled by the nurse as per the dosage and administration route recommended by doctor.
Comparison
Medication (DMARDS: Disease Modifying Anti-rheumatoid Drugs) only
Outcome
More satisfactory pain relief: The pain-relief will be accessed on basis of the pain
assessment by pain-score. The recovery from pain will be executed through improvement in
the extremity disability, improvement in the handgrip strength and increase in the self-
efficacy. The pain relief is also attained by improvement in the cardio-vascular functions like
promoting cardio-respiratory fitness along in increase in the flexibility of the wrists and other
joint parts

2
PICO QUESTION
Write out your research problem
Rheumatoid arthritis is an auto-immune disease that causes chronic inflammation in
joints. Unlike wear-and-tear damage of the osteo-arthritis, rheumatoid arthritis affects the
inner lining of the joints resulting in painful swelling that eventually leads to the development
of bone deformity and erosion of bones. The main symptoms of the rheumatoid arthritis (RA)
is swelling and pain in joints that hamper the quality of life of the adults along with
restriction in conducting daily living activities (Okada et al., 2014). The study conducted by
Van Dartel et al. (2013) further highlighted that pain among the patients with RA is
associated with fatigue. Increase level of fatigue associated with pain cause the daily life
experience debilitating, restricting day-to-day functioning. Increase in pain, increases the
severity if fatigue resulting in mood swings, behavior and beliefs. In relation to the
intervention, Van Dartel et al. (2013) highlighted that decrease in pain leads to decrease in
the severity of fatigue and thereby helping to execute daily living activities. Lee et al. (2013)
are of the opinion that pain among the patients with RA hampers the quality of sleep at night.
The peripheral inflammation occurring in pain is modulated by the central nervous system.
Conditioned modulation of pain by the central nervous system hampers the quality of life of
the adults with RA. Andersson, Svensson and Bergman (2013) further stated that chronic
wide-spread pain among the patients with rheumatoid arthritis cause swollen joint, poor
cardiac activity. This restricted movement create barrier towards successful accomplishments
of daily living activities and thereby hampering the overall quality of life.
In order to manage pain, the use of the Disease Modifying Anti-rheumatoid Drugs
(DMARD) is recommended by the healthcare professionals. One of the well known DMARD
include Tubastatin. Tubastatin is a selective histone deacetylase 6 inhibitor, which is found to
display anti-inflammatory and anti-rheumatic effects. Tubastatin mainly executes it function
by inhibiting cytokines TNF-alpha and IL-6 under the action of the THP-1 marcophages