title: Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: effectiveness and clinically significant change.
abstract: Interdisciplinary pain management programs have an established record of significantly improving the functioning of persons disabled with chronic pain. There is a group of pain sufferers, however, who have difficulty accessing these programs and for whom the effectiveness of these treatments in unknown, these are patients whose mobility and self-care deficits leave them unable to meet the practical demands of many treatment environments. The purpose of this study was to examine the results of a treatment program designed to meet the needs of these highly disabled individuals (n=53) in comparison to results obtained from a standard less-disabled group attending treatment at the same facility (n=234). Results from the highly disabled patients showed statistically significant change after treatment in eight of nine outcome variables, including improvements in pain-related distress, disability, depression, pain-related anxiety, daytime rest, and performance during an activity tolerance test. Effect size calculations showed a number of large treatment effects, for psychosocial disability, depression, and acceptance of pain. Analysis of reliable change and clinical significance demonstrated that results were not merely statistically significant but clinically meaningful. Results appeared stable at three months following treatment. This research plays an important part in establishing an evidence base to inform service development, ensuring that chronic pain services do not exclude people on the basis of the severity of their disability.
authors.affiliation: Pain Management Unit, Royal National Hospital for Rheumatic Diseases, University of Bath, Upper Borough Walls, Bath BA1 1RL, UK. Lance.McCracken@rnhrd-tr.swest.nhs.uk
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
authors.forename: Fiona
authors.initials: F
authors.lastname: MacKichan
authors.forename: Christopher
authors.initials: C
authors.lastname: Eccleston
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003863:Depression / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000523:psychology* / Q000628:therapy*; D010348:Patient Care Team / Q000706:statistics & numerical data / Q000639:trends; D011584:Psychology; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome