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Other psychological approaches
Abstracts (954) Children‘s use of imagery before and after surgery M. Huth; Case Western Reserve University, Cleveland, OH This experimental study investigated the effectiveness of using imagery, plus routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain in 7-12-year old children during ambulatory surgery (AS) and at home. This is descriptive data on the treatment group‘s use of imagery. Seventy-three children were randomly assigned to two groups from five AS settings. The 36 children in the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30-minute audiotape of imagery approximately one week prior to surgery (T1). They listened to only the audiotape one to four hours after surgery (T2) and 22-27 hours after discharge from AS (T3). Imagery was evaluated with the Imagery Assessment Questionnaire (IAQ). A home diary was used to record information on imagery tape use and level of relaxation. Descriptive statistics were used to examine the independent variable imagery. A paired sample t-test was used to compare differences in frequency of tape use. The Wilcoxon signed-ranks test was used to test the significance of changes in imagery scores between time points. Imagery tapes were used significantly more times before surgery than at home after surgery (p ⬍ .001). There were no significant changes in children‘s imagery scores at T1 and T2 (p ⬎ .05) and between T2 and T3 (p ⬎ .05). Children most often imagined going to the park when they used the tape (n ⫽ 21, 58 %). More frequent use of the imagery tape before surgery may be due to the child‘s motivation to cope with a potentially threatening environment. No significant change in imagery scores across settings indicates that children are able to imagine when in a stressful environment. Children‘s choice of a park is most likely related to the suggestions for picturing a park-like setting presented in the tape.
F04 - Other Psychological Approaches (955) A qualitative investigation of parents’ experiences of caring for an adolescent with chronic pain A. Jordan, C. Eccleston, L. McCracken, H. Connell, J. Clinch, C. Sourbut, M. Sleed; Pain Management Unit, University of Bath and Royal National Hospital for Rheumatic Diseases, Bath, UK Previous quantitative research has shown that parents/carers of adolescents with chronic pain report high levels of emotional distress, severe limitations in social and family functioning, increased financial hardship, and increased use of health care resources. This study aimed to further explore this parental impact by employing qualitative methodology to investigate parents’ experiences of caring for an adolescent with chronic pain. A sample of 18 parents/carers of adolescents with chronic pain were selected from two clinic sites. Participants comprised of 11 mothers, 5 fathers, 1 grandmother and 1 family friend. Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Group discussions were tape-recorded, anonymised and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA). Additional analyses were conducted to account for the dynamics of group interaction. A number of themes emerged from the IPA including ‘struggle’, ‘challenge of the parental role’, ‘parental distress’, ‘shift in familial relationships’ and ‘salience of medical knowledge and services’. Parents were highly distressed by their inability to alleviate their child‘s pain and felt that this contradicted their view of a parent as someone who can ‘make things better’. Participants emphasized that caring for an adolescent with chronic pain is a constant ‘struggle’, consuming vast amounts of energy, time and financial resources. Parents also discussed practical ways in which they have adapted their lives and those of their family members to care for an adolescent with chronic pain. Understanding of others, particularly medical professionals dominated the lives of participants. In addition to providing an understanding of parental experiences of caring for an adolescent with chronic pain, these research findings will also be used to inform the development of an inventory to measure the parental impact of caring for an adolescent with chronic pain.
97 (956) Further development of the multidimensional pain readiness to change questionnaire W. Nielson, L. Maleus, M. Jensen, R. Kerns; Arthritis Institute, St. Joseph‘s Health Care London, London, ON The present study describes further development and revision of the Multidimensional Pain Readiness to Change Questionnaire (MPRCQ.V2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. Four samples of participants were independently recruited from a Rheumatology Outpatient Clinic (n ⫽ 44), Arthritis Day Program (n ⫽ 22), Fibromyalgia Day Program (n ⫽ 30) and patient support groups (n ⫽ 24). The results indicate strong support for the reliability and validity of the MPRCQ.V2. In addition, comparison of the four samples suggests that the MPRCQ.V2 may allow differentiation of groups based upon the members’ level of readiness to change. On average, participants in the Fibromyalgia Day Program appear to be less ready to change than patients in the other programs in the areas of task persistence (p ⬍ .05), use of cognitive pain control strategies (p ⬍ .05), activity pacing (p ⬍ .01), assertive communication (p ⬍ .05), and proper body mechanics (p ⬍ .01). Further research is necessary in order to understand these differences from both theoretical and clinical perspectives.
(957) Applying the transtheoretical model to medical interventions for chronic pain: Implications for psychological evaluations and treatment recommendations P. Brawer, A. Cook, D. Chastain; University of Virginia Pain Management Center, Charlottesville, VA The Transtheoretical Model (TM) has proven to be an effective tool with regard to conceptualizing and predicting an individual‘s ability to modify behavior. One construct within the TM is the Stages of Change, which indicates an individual‘s readiness to modify their behavior. Kerns’ et al (1997), developed the Pain Stages of Change Questionnaire (PSOCQ) to assess a patient‘s readiness to adopt a self-management approach to chronic pain. Our study examined the PSOCQ specifically with regard to the appropriateness of its use as an assessment tool for a population of chronic pain patients seeking medical treatment. Patients were 221 (43.8 average age, 49.8% male) chronic pain patients, undergoing psychological evaluation for their appropriateness for spinal cord stimulators, intrathecal pumps, or chronic opioid treatment. Addressing differences in the PSOCQ literature, we employed both a correlational, as well as, a categorical approach in assessing PSOCQ profiles. As predicted, the PSOCQ was correlated in the appropriate direction with all of the risk factors that we identified (hopelessness, cognitive risk, total pain, disability, self-efficacy, and catastrophizing). Differences in risk factors by Stages of Change categories was evaluated by a one-way MANOVA with four groups (Precontemplation, Contemplation, Action, Maintenance). A significant result was found using Wilk‘s-Lambda criterion F(18, 571) ⫽ 5.446,p ⬍.001. Follow up univariate analyses indicated significant group differences for all dependent measures except disability. Discussion centers on the appropriateness of the PSOCQ as an assessment measure for patients seeking medical treatments for chronic pain, as well as, treatment implications for patients based on their readiness to participate in ongoing medical interventions.
F04 - Other Psychological Approaches (955) A qualitative investigation of parents’ experiences of caring for an adolescent with chronic pain A. Jordan, C. Eccleston, L. McCracken, H. Connell, J. Clinch, C. Sourbut, M. Sleed; Pain Management Unit, University of Bath and Royal National Hospital for Rheumatic Diseases, Bath, UK Previous quantitative research has shown that parents/carers of adolescents with chronic pain report high levels of emotional distress, severe limitations in social and family functioning, increased financial hardship, and increased use of health care resources. This study aimed to further explore this parental impact by employing qualitative methodology to investigate parents’ experiences of caring for an adolescent with chronic pain. A sample of 18 parents/carers of adolescents with chronic pain were selected from two clinic sites. Participants comprised of 11 mothers, 5 fathers, 1 grandmother and 1 family friend. Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Group discussions were tape-recorded, anonymised and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA). Additional analyses were conducted to account for the dynamics of group interaction. A number of themes emerged from the IPA including ‘struggle’, ‘challenge of the parental role’, ‘parental distress’, ‘shift in familial relationships’ and ‘salience of medical knowledge and services’. Parents were highly distressed by their inability to alleviate their child‘s pain and felt that this contradicted their view of a parent as someone who can ‘make things better’. Participants emphasized that caring for an adolescent with chronic pain is a constant ‘struggle’, consuming vast amounts of energy, time and financial resources. Parents also discussed practical ways in which they have adapted their lives and those of their family members to care for an adolescent with chronic pain. Understanding of others, particularly medical professionals dominated the lives of participants. In addition to providing an understanding of parental experiences of caring for an adolescent with chronic pain, these research findings will also be used to inform the development of an inventory to measure the parental impact of caring for an adolescent with chronic pain.
97 (956) Further development of the multidimensional pain readiness to change questionnaire W. Nielson, L. Maleus, M. Jensen, R. Kerns; Arthritis Institute, St. Joseph‘s Health Care London, London, ON The present study describes further development and revision of the Multidimensional Pain Readiness to Change Questionnaire (MPRCQ.V2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. Four samples of participants were independently recruited from a Rheumatology Outpatient Clinic (n ⫽ 44), Arthritis Day Program (n ⫽ 22), Fibromyalgia Day Program (n ⫽ 30) and patient support groups (n ⫽ 24). The results indicate strong support for the reliability and validity of the MPRCQ.V2. In addition, comparison of the four samples suggests that the MPRCQ.V2 may allow differentiation of groups based upon the members’ level of readiness to change. On average, participants in the Fibromyalgia Day Program appear to be less ready to change than patients in the other programs in the areas of task persistence (p ⬍ .05), use of cognitive pain control strategies (p ⬍ .05), activity pacing (p ⬍ .01), assertive communication (p ⬍ .05), and proper body mechanics (p ⬍ .01). Further research is necessary in order to understand these differences from both theoretical and clinical perspectives.
(957) Applying the transtheoretical model to medical interventions for chronic pain: Implications for psychological evaluations and treatment recommendations P. Brawer, A. Cook, D. Chastain; University of Virginia Pain Management Center, Charlottesville, VA The Transtheoretical Model (TM) has proven to be an effective tool with regard to conceptualizing and predicting an individual‘s ability to modify behavior. One construct within the TM is the Stages of Change, which indicates an individual‘s readiness to modify their behavior. Kerns’ et al (1997), developed the Pain Stages of Change Questionnaire (PSOCQ) to assess a patient‘s readiness to adopt a self-management approach to chronic pain. Our study examined the PSOCQ specifically with regard to the appropriateness of its use as an assessment tool for a population of chronic pain patients seeking medical treatment. Patients were 221 (43.8 average age, 49.8% male) chronic pain patients, undergoing psychological evaluation for their appropriateness for spinal cord stimulators, intrathecal pumps, or chronic opioid treatment. Addressing differences in the PSOCQ literature, we employed both a correlational, as well as, a categorical approach in assessing PSOCQ profiles. As predicted, the PSOCQ was correlated in the appropriate direction with all of the risk factors that we identified (hopelessness, cognitive risk, total pain, disability, self-efficacy, and catastrophizing). Differences in risk factors by Stages of Change categories was evaluated by a one-way MANOVA with four groups (Precontemplation, Contemplation, Action, Maintenance). A significant result was found using Wilk‘s-Lambda criterion F(18, 571) ⫽ 5.446,p ⬍.001. Follow up univariate analyses indicated significant group differences for all dependent measures except disability. Discussion centers on the appropriateness of the PSOCQ as an assessment measure for patients seeking medical treatments for chronic pain, as well as, treatment implications for patients based on their readiness to participate in ongoing medical interventions.