Cognitive/behavioral approaches: What factors predict reduction in pain severity in a pain rehabilitation program

Abstract

A most desirable outcome of a pain management program from a patient's perspective is likely to be a reduction in pain. From a behavioral program perspective, the outcome of improved functioning is more relevant because no surgical or medical treatments take place to specifically reduce the pain severity. Physical activity is generally associated with increased pain severity. This study examines variance in pain severity predicted beyond activity level (ie. mood and coping variables) in 440 patients completing a multidisciplinary, behaviorally oriented rehabilitation program. Patients completed measures of pain severity, depression, catastrophizing, general activity levels on admission and discharge. Paired t-tests revealed significant pre-post treatment improvement (p<.001) in all variables. Seventy percent (70%) of the patients completing the program reported a reduction in pain severity. Hierarchical regression analyses predicted 34% of the variance in pain severity following rehabilitation. At discharge, gender, education, pain site and duration of pain did not significantly predict variance in pain severity. General activity level predicted 9% of the variance in pain severity. Beyond activity level, depression predicted 10% and perceived interference from pain in daily life and catastrophizing each predicted an additional 6%. These results suggest that activity level, mood and coping are associated with pain severity. Contrary to common belief, general activity levels had a negative correlation (r=-.32) with pain severity. Depression, interference and catastrophizing are positively correlated (p<.001) with decreased pain severity. This study suggests that a rehabilitative approach to pain that incorporates therapies to increase physical functioning can help patients achieve an outcome of reduced pain severity.