The importance of behaviour change interventions in the management of Raynaud’s

Date: Fri 8th February 2019

Advice concerning limiting stress by practicing mindfulness is commonly given by doctors, alongside reducing exposure to the cold, in order to prevent Raynaud's attacks. But are these self-management techniques backed up by research?

Raynaud's phenomenon, the excessive constriction of blood vessels due to cold exposure and emotional stress, can have a dramatic effect on the quality of a person's life. This is due to attacks resulting in pain and a burning or tingling sensation, which may cause loss of function and distress. It is a fairly common condition, affecting approximately 5% of the population, and is associated with characteristic colour changes in the fingers and toes. Vasodilator medications, which function to open up blood vessels in order to restore blood flow into the hands and feet, can have adverse effects, therefore much attention is given to self-management measures.

Although self-management measures are almost always included in medical recommendations for Raynaud's, the advice does not extend beyond avoiding cold exposure, limiting heat loss, stopping smoking, increasing exercise and reducing stress levels. Behavioural and lifestyle changes such as these are difficult to implement successfully, with between 30-50% of patients showing poor adherence to these recommendations. This is perhaps because there has been limited research on the efficacy and adoption of lifestyle interventions. There is an evident need for evaluation, as up to a third of Raynaud's episodes are stress or anxiety related, and the remainder associated with cold exposure; this means that episodes are potentially avoidable.

A literature review conducted by Dr J Daniels, Dr J Pauling and Professor C Eccleston, and published in the British Medical Journal, aimed to evaluate the efficiency of behaviour change interventions for Raynaud's and identify how these could be used for future treatment development. 'Behaviour change interventions' are changes which aim to achieve symptomatic relief of Raynaud's through advised and sustained change in patient behaviour, by improving either physical or psychological well-being. Despite the huge impact of Raynaud's on quality of life, the development of behavioural and lifestyle interventions in similar conditions, and the significant potential benefit of self-management interventions (given the importance of cold exposure and stress as Raynaud's factors), there has been a surprising lack of therapy development and little work has been undertaken in this field in the last 20 years.

Fundamentally, this means that there is no evidence to either support or refute the suggestions made by the National Institute of Health and Care Excellence (NICE), even though there is clear evidence for the effective treatment of anxiety and pain in other long-term conditions, such as rheumatoid arthritis, and the importance attached to self-management in healthcare guidelines for Raynaud's. Therefore, there is a strong case for testing behaviour change interventions that focus on self-management.

Data of this kind can be used to develop guidelines for those living with Raynaud's that is based on evidence, which in turn may encourage individuals to take on this advice and improve their quality of life and wellbeing. Until then, however, SRUK urges all those living with Raynaud's to take on board the advice provided by medical professionals, such as stopping smoking and taking measures to stay as warm as possible, as together these will help to improve symptoms.

If you are interested in helping SRUK to fund more work like this, then please visit our donations page. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.

If you would like advice on managing symptoms associated with Raynaud's, please visit: Managing Raynaud's.

Information on another new piece of research into Raynaud's can be found here: Is there a better way to differentiate primary and secondary Raynaud's