Chung Jung Mun1, John D Otis2,3, John Concato4,5, M Carringotn Reid6, Matthew M Burg4,7, Rebecca Czlapinski8, Robert D Kerns8,9,10,11. 1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD. 2. Department of Psychiatry, Boston University School of Medicine. 3. Research Service, VA Boston Healthcare System, Boston, MA. 4. Departments of Internal Medicine. 5. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven. 6. Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY. 7. Anesthesiology. 8. Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System. 9. Psychiatry. 10. Neurology, Yale School of Medicine. 11. Department of Psychology, Yale University, New Haven, CT.
Abstract
OBJECTIVES: In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients' readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back pain patients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up. METHODS: Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments. RESULTS: Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up. CONCLUSIONS: Changes in patients' attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.
OBJECTIVES: In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients' readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back painpatients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up. METHODS:Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments. RESULTS: Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up. CONCLUSIONS: Changes in patients' attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.