title: Stages of change in readiness to adopt a self-management approach to chronic pain: the moderating role of early-treatment stage progression in predicting outcome.
abstract: Relative readiness to assume a self-management approach to chronic pain can be conceptualised as a stage model. Although both initial stage (precontemplation, action) and changes in attitudes reflecting stage orientation have been shown to predict treatment outcome, the joint contributions of these factors need to be examined. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary pain program, completed the Pain Stages of Change Questionnaire (PSOCQ), subscales of the Multidimensional Pain Inventory, and the Beck Depression Inventory at pre-, mid- and post-treatment. Patients were assigned to stage group (precontemplation or action) based on whether their Precontemplation or Action subscale scores were highest. Results showed that: (a) stage group interacted with pre- to mid-treatment Precontemplation subscale changes to predict mid- to late-treatment pain severity and interference changes such that precontemplation attitude decreases were related to reduced pain and interference only among patients who were already action stage at pre-treatment; (b) stage group interacted with pre- to mid-treatment Action subscale changes to predict mid- to late-treatment interference and activity changes such that action attitude increases were related to reduced interference and increased activity only among patients at the action stage at pre-treatment; (c) pre- to mid-treatment decreases in depression did not account for these effects. Results suggest that any advantage enjoyed by patients with predominant action attitudes at pre-treatment may be enhanced by consolidating a pain self-management approach during treatment. In contrast, late-treatment gains of patients initially taking a predominant precontemplation stance were unaffected by their degree of early-treatment attitude changes.
authors.affiliation: Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, USA UCLA Division of Cancer Prevention and Control Research, Los Angeles, CA, USA Pain and Rehabilitation Center of Chicago, Chicago, IL, USA Vanderbilt University, Nashville, Tennessee, USA Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.forename: Beth
authors.initials: B
authors.lastname: Glenn
authors.forename: Ken
authors.initials: K
authors.lastname: Lofland
authors.forename: Stephen
authors.initials: S
authors.lastname: Bruehl
authors.forename: Norman R
authors.initials: NR
authors.lastname: Harden
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications; D010146:Pain / Q000209:etiology / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D012648:Self Care; D016896:Treatment Outcome