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Predictive validity of pain readiness to change and self-efficacy for adherence and goal accomplishment in pain treatment
Abstracts (827) Sociodemographic factors and attitudes toward pain S. Park, N. Sonty; Columbia University, New York, NY There has been considerable interest in exploring a causal relationship between psychosocial variables (age, education, and marital status), chronic pain, and subsequent disability. Moreover, pain perceptions and attitudes including perceived disability and the belief that one can control pain have been implicated as mediating variables influencing coping behavior. With the hypothesis that demographic variables influence attitudes, perception of disability, and quality of life in chronic pain patients, the present study examined the role of gender, marital status, level of education, and pain chronicity in individuals’ attitudes and beliefs regarding pain and its impact on function. In a sample of chronic pain patients (N⫽88), three self-report measures – the Survey of Pain Attitude (SOPA), the Oswestry Low Back Pain Functional Disability Scale and a quality of life measure – were used. Pearson’s correlation and t-tests were used to examine the relationship between demographic variables and pain beliefs. The results showed that patients with higher education perceived pain as less disabling (r⫽⫺.33, p⫽.01) and less as an indicator of bodily harm (r⫽⫺.32, p⫽.015), than those less educated. Higher levels of education also correlated significantly with different indices of quality of life. Individuals with higher education reported that pain interfered less with their general activity level (r⫽⫺.37, p⫽.004), walking ability (r⫽⫺.29, p⫽.024), normal work routine (r⫽⫺.36, p⫽.005), sleep (r⫽⫺.33, p⫽.011), and ability to concentrate (r⫽⫺.30, p⫽.02), in spite of not finding significant differences in pain ratings across educational levels, F(3)⫽1.72, p⫽.17. Results also indicated that married patients were less likely to believe that their pain was affected by their emotional state (t⫽2.06, p⫽.04), and that pain interfered with their normal work routine (t⫽2.28, p⫽.026), compared to patients who were not married. Our findings highlight the role of sociodemographic variables in determining perception of pain-related disability and attitudes toward pain.
(828) Sociocultural understandings of the cause of Fibromyalgia M. Iraklidou, C. Eccleston; Pain Management Unit, The University of Bath, Bath, UK Fibromyalgia is a debilitating chronic pain condition that leads to extensive distress and disability. The clinical presentation is commonly characterized by a lack of professional and/or patient agreement as to the cause of this chronic problem. There are a large number of professional and lay theories as to the possible reasons for chronic pain and disability. We undertook a Q factor analytic study of the common understandings in Western medical culture. 340 separate statements were sampled from various written and spoken texts about Fibromyalgia, that were distilled and reduced to a final sample of 64. Forty six patients, professional, and lay members with an interest in Fibromyalgia completed the Q procedure by sorting the statements into levels of agreement, and by completing open feedback on each statement. Q factor analysis with varimax rotation and a cut-off eigen value of 0.6 revealed six independent factors. These were labelled: behavioural management, randomly indiscriminate, environmental, suppressed emotional conflict, broken body, and social forces. These factors are discussed as narratives that are available in culture to account for a contested chronic illness. The findings are discussed in relation to the defense of identity in chronic pain, and the role of illness legitimation in pain and symptom management.
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F30 - Other (829) Pain recall predicts future pain level J. Gedney, H. Logan; University of Florida, Gainesville, FL Annually, 25 million Americans experience pain due to injury or surgery and another 50 million suffer chronic pain. Often patients undergo repeated and painful interventions over the course of their active treatment. Given the complex biopsychosocial milieu in which pain experiences are filtered, we wished to explore the extent to which memory of a painful exposure may influence pain reporting to a subsequent, repeat exposure. Twenty-six men and 17 women (mean age ⫽ 26.2, SD⫽5.4) completed both a baseline forehead cold pressor pain task session and an identical session nine months later (mean months ⫽ 8.8, SD⫽1.9). Numeric pain ratings (0-10) were provided every 10 seconds during the two minute pain tasks. A telephone interview was conducted six months after the first session (mean months⫽6.6, SD⫽1.5) at which time subjects provided numeric pain ratings of their recalled level of first session maximum pain. Hierarchical regression analyses were used to examine pain report relationships. Second session maximum pain was entered as the dependent measure. Predictor variables were maximum first session pain and first session maximum pain recall. Predictor variables were loaded in separate models in reverse order to compute unique variance for each predictor variable and their shared variance. Results showed that when both variables were entered into the model pain recall was a significant independent predictor (R2⫽.28, p⬍.01) whereas experienced first session maximum pain was not (R2⫽.02). Twenty-five percent of the total variance was shared between the two predictor variables (p⬍.01). We conclude that when the period of pain recall and pain re-exposure is approximately six months, pain recall is a more predictive of subsequent pain reporting than is the initial pain level. These findings demonstrate the importance of pain memory processing as a significant modulator of subsequent pain reporting and have important clinical implications for patients with pain.
(830) Predictive validity of pain readiness to change and selfefficacy for adherence and goal accomplishment in pain treatment A. Heapy, J. Otis, K. Marcus, L. Frantsve, E. Janke, M. Shulman, R. Kerns; VA CT Healthcare System, West Haven, CT It has been suggested that the construct of pain readiness to change adds little to our understanding of motivation for pain treatment beyond what is already known about the role of self-efficacy. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. The PSOCQ is comprised of four scales (Precontemplation, Contemplation, Action, and Maintenance) that assess patients’ readiness to adopt a self-management approach to chronic pain. SE was the mean subject certainty of achieving up to five behavioral treatment goals. Data were collected as part of a larger randomized controlled trial of primary care based CBT. At pretreatment Ss completed the PSOCQ and SE measure. Criteria were means of aggregated ratings of intersession goals over the course of treatment and mean post-treatment goal accomplishment. Participants were 78 patients recruited from a VA primary care clinic. SE and two of the PSOCQ variables were significantly correlated at pre-treatment (SE/Contemplation r ⫽ .319, p⬍ .05; SE/Action r ⫽ .308, p ⬍ .05). Pre-treatment PSOCQ variables significantly predicted intersession adherence (R2 ⫽ .231, p ⬍ .05) and goal accomplishment (ƒxR2 ⫽ .152, p ⬍ .01) even after controlling for the effect of treatment condition. SE did not significantly predict either criterion. These data provide additional support for the predictive validity of the PSOCQ and the relevance of the pain readiness to change construct in understanding the process of change during self-management treatments for chronic pain.
(828) Sociocultural understandings of the cause of Fibromyalgia M. Iraklidou, C. Eccleston; Pain Management Unit, The University of Bath, Bath, UK Fibromyalgia is a debilitating chronic pain condition that leads to extensive distress and disability. The clinical presentation is commonly characterized by a lack of professional and/or patient agreement as to the cause of this chronic problem. There are a large number of professional and lay theories as to the possible reasons for chronic pain and disability. We undertook a Q factor analytic study of the common understandings in Western medical culture. 340 separate statements were sampled from various written and spoken texts about Fibromyalgia, that were distilled and reduced to a final sample of 64. Forty six patients, professional, and lay members with an interest in Fibromyalgia completed the Q procedure by sorting the statements into levels of agreement, and by completing open feedback on each statement. Q factor analysis with varimax rotation and a cut-off eigen value of 0.6 revealed six independent factors. These were labelled: behavioural management, randomly indiscriminate, environmental, suppressed emotional conflict, broken body, and social forces. These factors are discussed as narratives that are available in culture to account for a contested chronic illness. The findings are discussed in relation to the defense of identity in chronic pain, and the role of illness legitimation in pain and symptom management.
S65
F30 - Other (829) Pain recall predicts future pain level J. Gedney, H. Logan; University of Florida, Gainesville, FL Annually, 25 million Americans experience pain due to injury or surgery and another 50 million suffer chronic pain. Often patients undergo repeated and painful interventions over the course of their active treatment. Given the complex biopsychosocial milieu in which pain experiences are filtered, we wished to explore the extent to which memory of a painful exposure may influence pain reporting to a subsequent, repeat exposure. Twenty-six men and 17 women (mean age ⫽ 26.2, SD⫽5.4) completed both a baseline forehead cold pressor pain task session and an identical session nine months later (mean months ⫽ 8.8, SD⫽1.9). Numeric pain ratings (0-10) were provided every 10 seconds during the two minute pain tasks. A telephone interview was conducted six months after the first session (mean months⫽6.6, SD⫽1.5) at which time subjects provided numeric pain ratings of their recalled level of first session maximum pain. Hierarchical regression analyses were used to examine pain report relationships. Second session maximum pain was entered as the dependent measure. Predictor variables were maximum first session pain and first session maximum pain recall. Predictor variables were loaded in separate models in reverse order to compute unique variance for each predictor variable and their shared variance. Results showed that when both variables were entered into the model pain recall was a significant independent predictor (R2⫽.28, p⬍.01) whereas experienced first session maximum pain was not (R2⫽.02). Twenty-five percent of the total variance was shared between the two predictor variables (p⬍.01). We conclude that when the period of pain recall and pain re-exposure is approximately six months, pain recall is a more predictive of subsequent pain reporting than is the initial pain level. These findings demonstrate the importance of pain memory processing as a significant modulator of subsequent pain reporting and have important clinical implications for patients with pain.
(830) Predictive validity of pain readiness to change and selfefficacy for adherence and goal accomplishment in pain treatment A. Heapy, J. Otis, K. Marcus, L. Frantsve, E. Janke, M. Shulman, R. Kerns; VA CT Healthcare System, West Haven, CT It has been suggested that the construct of pain readiness to change adds little to our understanding of motivation for pain treatment beyond what is already known about the role of self-efficacy. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. The PSOCQ is comprised of four scales (Precontemplation, Contemplation, Action, and Maintenance) that assess patients’ readiness to adopt a self-management approach to chronic pain. SE was the mean subject certainty of achieving up to five behavioral treatment goals. Data were collected as part of a larger randomized controlled trial of primary care based CBT. At pretreatment Ss completed the PSOCQ and SE measure. Criteria were means of aggregated ratings of intersession goals over the course of treatment and mean post-treatment goal accomplishment. Participants were 78 patients recruited from a VA primary care clinic. SE and two of the PSOCQ variables were significantly correlated at pre-treatment (SE/Contemplation r ⫽ .319, p⬍ .05; SE/Action r ⫽ .308, p ⬍ .05). Pre-treatment PSOCQ variables significantly predicted intersession adherence (R2 ⫽ .231, p ⬍ .05) and goal accomplishment (ƒxR2 ⫽ .152, p ⬍ .01) even after controlling for the effect of treatment condition. SE did not significantly predict either criterion. These data provide additional support for the predictive validity of the PSOCQ and the relevance of the pain readiness to change construct in understanding the process of change during self-management treatments for chronic pain.