title: Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain?
abstract: There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitive-behavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.
authors.affiliation: Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia. michael.nicholas@sydney.edu.au
authors.forename: M K
authors.initials: MK
authors.lastname: Nicholas
authors.forename: A
authors.initials: A
authors.lastname: Asghari
authors.forename: M
authors.initials: M
authors.lastname: Corbett
authors.forename: R J E M
authors.initials: RJ
authors.lastname: Smeets
authors.forename: B M
authors.initials: BM
authors.lastname: Wood
authors.forename: S
authors.initials: S
authors.lastname: Overton
authors.forename: C
authors.initials: C
authors.lastname: Perry
authors.forename: L E
authors.initials: LE
authors.lastname: Tonkin
authors.forename: L
authors.initials: L
authors.lastname: Beeston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058443:Catastrophization / Q000523:psychology; D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy*; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000523:psychology*; D003887:Desensitization, Psychologic; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005239:Fear / Q000523:psychology; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult