Investigating the Effectiveness of Drug Administration and Relaxation Therapy in Reducing Pain and Sleep Disorders in Rheumatoid Arthritis Patients
Keywords:
Drug Therapy, Relaxation Therapy, Chronic Pain, Sleep Disorders, Rheumatoid ArthritisAbstract
Objective: Rheumatoid arthritis is a long-lasting inflammatory condition that causes joint pain, stiffness, and sleep disorders, significantly impacting the well-being of individuals. The purpose of this research was to examine the efficacy of drug administration and relaxation therapy in alleviating pain and improving sleep quality in patients with rheumatoid arthritis.
Methods and Materials: The study used a quasi-experimental research design, including pre-test, post-test, and four months’ follow-up. The study consisted of three groups: two experimental groups (one receiving drug therapy and the other receiving relaxation therapy) and a control group. The research included all patients diagnosed with rheumatoid arthritis and referred to the Iranian Rheumatology Center in Tehran from July to December 2023 as the statistical population. The sample included 60 participants who were selected using purposive sampling methods. In the drug therapy group, each patient was prescribed 3 mg of melatonin daily for one month. The relaxation therapy group, consisting of 20 participants, received six 90-minute sessions once a week, both in person and at home. The in-person sessions were held in suitable offices under the supervision of the Rheumatology Center. The research utilized the Pittsburgh Sleep Quality Index (PSQI) and the McGill Pain Questionnaire (MPQ) as research instruments. The data was analyzed statistically using the Kruskal-Wallis H method and analysis of covariance with repeated measures at a p-value of 0.05, utilizing SPSS statistical software version 27.
Findings: Based on the findings, the P-value for Between-Subjects Effects showed significance for the sleep disorder variable (p<0.001). Similarly, there was significance in the interaction effects between time and groups for the sleep disorder variable (p=0.004). In addition, the P-value for Between-Subjects Effects was also significant for the sensory pain variable (p<0.001). The study also discovered that the relationship between time and groups, along with the impacts within each group, were both statistically significant for the sensory pain variable (p>0.05). However, no differences were observed in any of the groups and stages for the emotional pain variable, indicating that the intervention methods did not affect emotional pain.
Conclusion: The current study found that drug therapy is successful in decreasing sleep disorders and providing long-term relief from sensory pain. On the other hand, relaxation therapy is not as effective as medication in reducing pain and sleep disorders. These findings will assist medical professionals in making informed decisions when selecting treatments for patients with rheumatoid arthritis.
Downloads
References
Abdelrahman, M. S., Shaddad, A. M., Khaleel, W. G. E., Talaat, E. A., Safwat, S. M., & Farrag, S. (2024). Sleep quality, anxiety, depression, and quality of life in rheumatoid arthritis patients and impact of disease activity. Egyptian Rheumatology and Rehabilitation, 51(1), 10. https://doi.org/10.1186/s43166-024-00242-z
Alimoradian, A., Garshasbi, M., Asafari, M., Golitaleb, M., Tabar, R. M., Mortaji, S., & Tajik, R. (2023). Effect of silymarin on hepatic complications caused by methotrexate and its analgesic effects in patients with rheumatoid arthritis. 10.61186/sjku.28.4.95
Amin, M. R., Siratinayer, M., Abadi, A., & Moradyan, T. (2012). Correlation between visual analogue scale and short form of McGill questionnaire in patients with chronic low back pain. https://www.cabidigitallibrary.org/doi/full/10.5555/20123144997
Andrena, D., & Kurdi, F. (2023). Application of Relaxation Therapy on Chronic Pain in the Elderly with Hypertension at UPT PSTW Jember: A Case Study. Jurnal Kesehatan Komunitas Indonesia, 3(1), 59-80. doi.org/10.58545/jkki.v3i1.58
Ausserwinkler, M., Gensluckner, S., Frey, V., Gostner, I., Paulweber, B., Trinka, E., ... & Wernly, B. (2025). Cerebrovascular risk in rheumatoid arthritis patients: insights from carotid artery atherosclerosis in the Paracelsus 10,000 study. Rheumatology International, 45(2), 1-10. https://doi.org/10.1007/s00296-024-05781-4
Azzam, A. I. (2024). The impact of sleep problems on rheumatoid arthritis Disease Activity. Sleep Medicine Research, 15(2), 106-112. https://doi.org/10.17241/smr.2023.02075
Baerwald, C., Stemmler, E., Gnüchtel, S., Jeromin, K., Fritz, B., Bernateck, M., ... & Baron, R. (2024). Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain. Annals of the Rheumatic Diseases, 83(10), 1381-1388. https://doi.org/10.1136/ard-2023-225414
Bernstein, D. A., Borkovec, T. D., & Hazlett-Stevens, H. (2000). New directions in progressive relaxation training: A guidebook for helping professionals. Praeger Publishers/Greenwood Publishing Group. https://psycnet.apa.org/record/2000-03365-000
Brahem, M., Chebil, A., Abid, H., Jomaa, O., Sarraj, R., Jebali, B., ... & Younes, M. (2024). Sleep disorders in rheumatoid arthritis patients. The Egyptian Rheumatologist, 46(3), 107-111. https://doi.org/10.1016/j.ejr.2024.03.001
Buysse, D. J., Reynolds, C. F., Monk, T. H., Hoch, C. C., Yeager, A. L., & Kupfer, D. J. (1991). Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep, 14(4), 331-338. https://doi.org/10.1093/sleep/14.4.331
Das, D., & Choy, E. (2023). Non-inflammatory pain in inflammatory arthritis. Rheumatology, 62(7), 2360-2365. https://doi.org/10.1093/rheumatology/keac671
Destiani, D. P., Dewi, S., Sulaiman, S. A., Alfian, S. D., Barliana, M. I., & Abdulah, R. (2025). AMPD1 and MTHFR genes are not associated with calcium levels in rheumatoid arthritis patients with methotrexate therapy in Indonesia. Scientific Reports, 15(1), 1-8. https://doi.org/10.1038/s41598-024-69604-z
Dewi, R., Nurani, M. D., Fatmala, S. D., Wahida, A. Z., Budhiana, J., & Arsyi, D. N. (2022). The Five Finger Relaxation Techniques on Pain and Sleep Quality In Rhematic Patients In Sukabumi Village, Working Area Of The Selabatu Health Center, Sukabumi City. International Journal of Nursing and Health Services (IJNHS), 5(6), 501-510. https://doi.org/10.35654/ijnhs.v5i6.650
Ditmer, M., Gabryelska, A., Turkiewicz, S., Białasiewicz, P., Małecka-Wojciesko, E., & Sochal, M. (2021). Sleep problems in chronic inflammatory diseases: prevalence, treatment, and new perspectives: a narrative review. Journal of Clinical Medicine, 11(1), 67. https://doi.org/10.3390/jcm11010067
Domínguez-Casas, L. C., Ferraz-Amaro, I., Castañeda, S., & Blanco, R. (2025). Severe Respiratory Infections in Rheumatoid Arthritis Patients: An Observational Study of 528 Patients from a Single University Hospital. Journal of Clinical Medicine, 14(4), 1174. https://doi.org/10.3390/jcm14041174
Farshchian, N., Shirzadi, M., Farshchian, F., Tanhaye, S., Heydarheydari, S., & Amirifard, N. (2020). Evaluation of the melatonin effect on sleep quality in cancer patients. Tehran University of Medical Sciences Journal, 78(1), 38-42. http://tumj.tums.ac.ir/article-1-10371-fa.html
Golmakani, N. (2018). Comparison and correlation between visual analogue scale and different dimensions of the short form of McGill pain questionnaire in post cesarean pain evaluation. Nursing And Midwifery Journal, 16(9), 622-630. http://unmf.umsu.ac.ir/article-1-3611-en.html
Kang, H. (2021). Sample size determination and power analysis using the G* Power software. Journal of educational evaluation for health professions, 18. 10.3352/jeehp.2021.18.17
Kılıç, N., & Parlar Kılıç, S. (2023). The effect of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis: A randomized controlled trial. International Journal of Nursing Practice, 29(3), e13015. https://doi.org/10.1111/ijn.13015
Krijbolder, D. I., Verstappen, M., van Dijk, B. T., Dakkak, Y. J., Burgers, L. E., Boer, A. C., ... & van der Helm-van, A. H. (2022). Intervention with methotrexate in patients with arthralgia at risk of rheumatoid arthritis to reduce the development of persistent arthritis and its disease burden (TREAT EARLIER): a randomised, double-blind, placebo-controlled, proof-of-concept trial. The Lancet, 400(10348), 283-294. https://doi.org/10.1016/S0140-6736(22)01193-X
Liu, B., Qian, Y., Lin, H., Zhao, S., Ying, J., Chen, W., ... & Mao, Y. (2024). Sleep pattern, genetic risk, and the risk of incident rheumatoid arthritis: A cohort study. Sleep Health, 10(6), 635-642. https://doi.org/10.1016/j.sleh.2024.08.009
Mathias, K., Amarnani, A., Pal, N., Karri, J., Arkfeld, D., Hagedorn, J. M., & Abd-Elsayed, A. (2021). Chronic pain in patients with rheumatoid arthritis. Current Pain and Headache Reports, 25, 1-11. https://doi.org/10.1007/s11916-021-00973-0
Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring methods. pain, 1(3), 277-299. https://doi.org/10.1016/0304-3959(75)90044-5
Mirzaei, F., & Khodabakhshi-Koolaee, A. (2018). The relationship between sleep quality and perceived social support with loneliness in elderly men. Journal of Gerontology, 2(4), 11-20. http://joge.ir/article-1-182-en.html
Motyl, G., Krupka, W. M., & Maślińska, M. (2024). The problem of residual pain in the assessment of rheumatoid arthritis activity. Reumatologia, 62(3), 176. 10.5114/reum/189779
Mrid, R. B., Bouchmaa, N., Ainani, H., El Fatimy, R., Malka, G., & Mazini, L. (2022). Anti-rheumatoid drugs advancements: New insights into the molecular treatment of rheumatoid arthritis. Biomedicine & Pharmacotherapy, 151, 113126. https://doi.org/10.1016/j.biopha.2022.113126
Munir, M., Javaid, Z. K., Mahmood, K., Fareed, M., Mubeen, A., & Ali, A. L. (2024). Mediating Role of Quality of Life between Perceived Stress and Sleep Quality among Patients with Rheumatoid Arthritis. Journal of Health and Rehabilitation Research, 4(2), 1570-1575. https://doi.org/10.61919/jhrr.v4i2.1176
Palimi, T., Zilaee, M., Rajaei, E., & Karandish, M. (2022). Effects of Melatonin on Sleep Quality and Disease activity in patients with rheumatoid arthritis. Sleep Medicine Research, 13(1), 38-45. https://doi.org/10.17241/smr.2022.01207
Prasad, P., Verma, S., Surbhi, Ganguly, N. K., Chaturvedi, V., & Mittal, S. A. (2023). Rheumatoid arthritis: advances in treatment strategies. Molecular and cellular biochemistry, 478(1), 69-88. https://doi.org/10.1007/s11010-022-04492-3
Radwan, A., & Borai, A. (2021). Quality of sleep in rheumatoid arthritis patients: Relationship with disease activity, depression and functional status. The Egyptian Rheumatologist, 43(2), 183-187. https://doi.org/10.1016/j.ejr.2020.08.002
Rafeeqi, T. A., Pandith, R. A., Shah, A., Zakir, M., Anjum, N., Ara, I., & Ahmed, N. Z. (2025). Serum biomarkers in rheumatoid arthritis patients and effect of unani herbal formulation Qurs-e-hudar on these biomarkers suggesting the anti-IL-6 effect. Journal of Herbal Medicine, 100999. https://doi.org/10.1016/j.hermed.2025.100999
Singh, G., & Kumar, V. (2024). Sleep quality is poor in rheumatoid arthritis patients and correlates with anxiety, Depression, and poor quality of life. Mediterranean Journal of Rheumatology, 35(3), 423. 10.31138/mjr.221022.sqp
Weman, L., Salo, H., Kuusalo, L., Huhtakangas, J., Vähäsalo, P., Backström, M., ... & Sokka-Isler, T. (2024). Intense symptoms of pain are associated with poor sleep, fibromyalgia, depression and sleep apnea in patients with rheumatoid arthritis and psoriatic arthritis. A register-based study. Joint Bone Spine, 91(5), 105744. https://doi.org/10.1016/j.jbspin.2024.105744
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2024 Sogand Ghassemzadeh, Sana Rabiee, Ashraf Sharifian jazi, Faezeh Hashemi (Author); Zeynab AI Sadat Hosseini (Corresponding author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
