title: Adjustment to chronic pain in back pain patients classified according to the motivational stages of chronic pain management.
abstract: According to Prochaska's transtheoretical model, the Freiburg Questionnaire stages of chronic pain management (FQ-STAPM) were used to classify chronic back patients into 4 distinct motivational stages. The FQ-STAMP was completed by 163 chronic back pain patients. Pain chronicity was measured by the Mainz Pain Staging System; pain intensity was measured by the numeric rating scale. Healthcare system expenses were considered as number of consulted physicians, number of stays in hospital, and number of rehabilitation programs. As psychometric tests, the lower pain disability index (PDI), the Hospital Anxiety and Depression Scale (HADS), and a quality of life score (SF36) were used. Patients were in the following motivational stages: precontemplation in 30%, preparation in 19%, action in 30%, maintenance in 21%. The intensity of pain in the precontemplation stage patients was significantly higher compared to patients in the maintenance stage. A lower pain chronicity was related to a significantly higher motivation. Moreover, there was a significant increase in healthcare system expenses by the lesser motivated patients. Patients in the maintenance stage used significantly less opioids than patients in the precontemplation stage. The higher motivated patients had a significantly lower PDI, a significantly lower HADS, and a significantly higher quality of life compared to less motivated patients.
  
  
  CONCLUSIONS
  The study indicates that the FQ-STAPM might be a useful tool to classify chronic back pain patients and to work out a strategy together with the patient relevant to the outcome of pain management among chronic back pain patients.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité Campus Mitte, University Hospital Charité, Charité-University Medicine Berlin, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Zenker
authors.forename: Michael
authors.initials: M
authors.lastname: Petraschka
authors.forename: Michael
authors.initials: M
authors.lastname: Schenk
authors.forename: Anett
authors.initials: A
authors.lastname: Reisshauer
authors.forename: Tanja
authors.initials: T
authors.lastname: Newie
authors.forename: Kai
authors.initials: K
authors.lastname: Hermanns
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000523:psychology* / Q000628:therapy; D008297:Male; D009042:Motivation; D010147:Pain Measurement / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011584:Psychology; D011795:Surveys and Questionnaires / Q000592:standards*