Chronic Pain Management Program Research Articles

A New Perspective on Family Involvement in Chronic Pain Management Programmes

The aim of this study was to investigate how those with pain, and their significant others, perceive the involvement of significant others in a multidisciplinary chronic pain management programme. Semi-structured telephone interviews were conducted with eight people who had attended a Family Day as part of a three-week multidisciplinary chronic pain management programme in Auckland, New Zealand. Four of the participants had pain and four were significant others. Follow-up interviews were conducted with seven of the participants up to one year after their initial interview. Conventional content analysis was used to analyse collected data. Participants viewed the involvement of significant others to be important because managing pain necessitates 'being on the same page' and significant others also needed an opportunity to access support and information. The involvement of significant others in programmes is perceived to be important but must be a balance between what is feasible for significant others and beneficial for all. Further research into when and how significant others are included within programmes is urgently required.

Effects of an Individually Tailored Web-Based Chronic Pain Management Program on Pain Severity, Psychological Health, and Functioning

BackgroundIt is estimated that 30% of adults in the United States experience daily chronic pain. This results in a significant burden on the health care system, in particular primary care, and on the workplace. Chronic pain management with cognitive-behavioral psychological treatment is effective in reducing pain intensity and interference, health-related quality of life, mood, and return to work. However, the population of individuals with chronic pain far exceeds the population of therapists that can provide this care face-to-face. The use of tailored, Web-based interventions for the management of chronic pain could address limitations to access by virtue of its unlimited scalability.ObjectiveTo examine the effects of a tailored Web-based chronic pain management program on subjective pain, activity and work interference, quality of life and health, and stress.MethodsEligible participants accessed the online pain management program and informed consent via participating employer or health care benefit systems; program participants who completed baseline, 1-, and 6-month assessments were included in the study. Of the 645 participants, the mean age was 56.16 years (SD 12.83), most were female (447/645, 69.3%), and white (505/641, 78.8%). Frequent pain complaints were joint (249/645, 38.6%), back (218/645, 33.8%), and osteoarthritis (174/654, 27.0%). The online pain management program used evidence-based theories of cognitive behavioral intervention, motivational enhancement, and health behavior change to address self-management, coping, medical adherence, social support, comorbidities, and productivity. The program content was individually tailored on several relevant participant variables.ResultsBoth pain intensity (mean 5.30, SD 2.46), and unpleasantness (mean 5.43, SD 2.52) decreased significantly from baseline to 1-month (mean 4.16, SD 2.69 and mean 4.24, 2.81, respectively) and 6-month (mean 3.78, SD 2.79 and mean 3.78, SD 2.79, respectively) assessments (P<.001). The magnitude of the 6-month effects were large. Trends for decreases in pain interference (36.8% reported moderate or enormous interference) reached significance at 6 months (28.9%, P<.001). The percentage of the sample reporting fair or poor quality of life decreased significantly from 20.6% at baseline to 16.5% at 6 months (P=.006).ConclusionsResults suggest that the tailored online chronic pain management program showed promising effects on pain at 1 and 6 months posttreatment and quality of life at 6 months posttreatment in this naturalistic study. Further research is warranted to determine the significance and magnitude of the intervention’s effects in a randomized controlled trial.

A mixed‐method study exploring suffering and alleviation in participants attending a chronic pain management programme

To explore and describe the suffering of patients that arises from chronic pain, and the alleviation of this suffering within a chronic pain management programme. In this mixed-method study, we examined how quantitative findings can be integrated to answer a complex research question and expand qualitative findings. Suffering and grief often follow chronic pain and can involve a number of experiences. Therefore, understanding and explaining the chronic pain experience must incorporate subjective experiences and phenomenological dimensions. A qualitatively driven multiple mixed-method design. The qualitative core was supplemented with three quantitative sequential components and integrated after analyses in a result narrative. Thirty-four consecutive outpatients were recruited to an eight-week pain management programme that was founded on cognitive behavioural therapy. The qualitative core component consisted of asking the participants about their experiences of the programme after the completion and again after six months. Two quantitative questionnaires, measuring living with pain and grief and loss were administered at pretest, post-test and six-month follow-up. Satisfaction with the programme was measured after its completion. Both the qualitative reports and the quantitative data showed that the programme had been valuable and alleviated the participants' suffering. The written reports described the importance of group processes, increased self-understanding and other aspects that were meaningful to the participants. The quantitative data provided additional information about what and how the programme had been important to the participants. The findings clearly indicate that suffering can be alleviated by attending such programme as several key shifts in perspectives took place, and allowed them to move towards a better life. By attending such programme, patients may learn about cognitive and behavioural factors that contribute to chronic pain and suffering and how alleviation is possible through change of focus and active involvement.

Initial validation of a modified version of the Roland-Morris Disability Questionnaire (RMDQ) in a general chronic pain population

The original Roland Morris Disability Questionnaire (RMDQ) consists of 24 statements describing activity limitations stemming from back pain specifically, such as self-care and physical limitations. The RMDQ has shown good reliability and has also been utilized in languages other than English. An issue in many chronic pain clinics is that all types of pain from various anatomical structures are being treated, such as knee pain, wrist pain, etc., which raises the question of the ecological validity of the RMDQ when used with individuals suffering from chronic pain other than back pain. The current study examines the validity of a modified form of the RMDQ compared to the original version in individuals attending a multidisciplinary pain management clinic for chronic pain. Development of an instrument that can validly assess activity limitations due to chronic pain of various origins, not just back pain, is necessary in order to accurately assess the impact that an individual’s pain has on their functioning. Subjects were referrals for chronic pain management treatment with predominately low-back pain (62%) and a typical mix of other pain sites. Fifty sequential evaluations for admission into the interdisciplinary chronic pain management program were alternatively given the ORIGINAL or the MODIFIED RMDQ. Fifty sequential discharges from the 20-day interdisciplinary treatment were also alternatively given either version. A 2X2 ANOVA revealed a statistically significant PRE/POST reduction on both the ORIGINAL/MODIFIED versions (less self-rated disability). There were no significant mean differences between the two versions at either sample time nor was the interaction effect significant. The current investigation provides initial validation of a modified version of the RMDQ for a typical mix of individual referred to and participating in interdisciplinary pain management treatment. It is believed that such a modification allows more universal access to this type of self-reported disability questionnaire. The original Roland Morris Disability Questionnaire (RMDQ) consists of 24 statements describing activity limitations stemming from back pain specifically, such as self-care and physical limitations. The RMDQ has shown good reliability and has also been utilized in languages other than English. An issue in many chronic pain clinics is that all types of pain from various anatomical structures are being treated, such as knee pain, wrist pain, etc., which raises the question of the ecological validity of the RMDQ when used with individuals suffering from chronic pain other than back pain. The current study examines the validity of a modified form of the RMDQ compared to the original version in individuals attending a multidisciplinary pain management clinic for chronic pain. Development of an instrument that can validly assess activity limitations due to chronic pain of various origins, not just back pain, is necessary in order to accurately assess the impact that an individual’s pain has on their functioning. Subjects were referrals for chronic pain management treatment with predominately low-back pain (62%) and a typical mix of other pain sites. Fifty sequential evaluations for admission into the interdisciplinary chronic pain management program were alternatively given the ORIGINAL or the MODIFIED RMDQ. Fifty sequential discharges from the 20-day interdisciplinary treatment were also alternatively given either version. A 2X2 ANOVA revealed a statistically significant PRE/POST reduction on both the ORIGINAL/MODIFIED versions (less self-rated disability). There were no significant mean differences between the two versions at either sample time nor was the interaction effect significant. The current investigation provides initial validation of a modified version of the RMDQ for a typical mix of individual referred to and participating in interdisciplinary pain management treatment. It is believed that such a modification allows more universal access to this type of self-reported disability questionnaire.

Exploring the Effectiveness of a Mindfulness-Based Chronic Pain Management Course Delivered Simultaneously to On-Site and Off-Site Patients Using Telemedicine

The present study investigated the effectiveness of a mindfulness-based pain management program developed to increase accessibility and acceptability for a severe chronic pain population seeking help in two tertiary level hospital pain clinics. Sixty chronic pain patients completed a 12-week Mindfulness-Based Chronic Pain Management program, while 59 individuals on the waiting list served as a control group. Ages ranged from 32 to 79 (mean age 52), and classes contained a mix of on-site and distant-site participants connected via a telemedicine link. Quality of life, pain catastrophizing, usual pain levels, and pain-related suffering were measured at two points during the study period. Program participants showed significant improvements in mental health, pain catastrophizing, and suffering levels, while the controls remained relatively unchanged. Neither group showed significant changes in the physical quality of life measures or usual pain levels. The present study lends support for the effectiveness of mind–body interventions in improving mental health and suffering in chronic pain sufferers seeking help in tertiary pain clinic settings. It also provides evidence for the usefulness of a mindfulness-based program modified specifically for the chronic pain population, and supports its delivery through telemedicine.

Therapeutic writing and chronic pain: experiences of therapeutic writing in a cognitive behavioural programme for people with chronic pain

To examine the experiences of therapeutic writing from the perspectives of patients attending a chronic pain management programme. Pain is a multifaceted experience. Increased awareness, understanding and gaining new insights are essential aspects of dealing with chronic pain. It is crucial to find powerful ways to cope with chronic pain. Several studies point to writing as a tool for managing such demanding life experiences. Therapeutic writing in a cognitive behavioural approach may be used to facilitate the rehabilitation process. A qualitative study with a descriptive and explorative design including a phenomenological perspective was used. A consecutive sample of 34 outpatients with chronic pain was recruited to an eight-week group-based pain management programme. A therapeutic writing tool was developed and included as part of the homework tasks. Guidelines were used to initiate and guide the therapeutic writing activity. Written reports were collected after completion. Three thematic findings emerged from the analysis: 'increased understanding of chronic pain as a multifaceted experience', 'new insights into managing the chronic pain situation' and 'different performances lead to different experiences with therapeutic writing'. Increased awareness, understanding and new insights are essential to dealing with chronic pain. People with chronic pain need tools and skills for optimal adaptation. Our findings suggest therapeutic writing may strengthen cognitive behavioural therapy by facilitating cognitive restructuring processes. Therapeutic writing may be used as a tool to express individual experiences and to improve adaptation to chronic pain.

Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11)

To determine the psychometric properties of the 11-item Tampa Scale for Kinesiophobia (TSK-11) in patients with heterogeneous chronic pain. The study evaluated test-retest reliability (intra-class correlation coefficient), cross-sectional convergent construct validity (Pearson product-moment correlation between TSK-11 and the Pain Catastrophizing Scale [PCS] scores at admission), and sensitivity to change of the TSK-11 (area under the receiver operating characteristic [ROC] curve) in patients (n=74) with heterogeneous chronic pain. We used two data sets (retrospective, n=56; prospective, n=18). All patients attended the 4-week interdisciplinary chronic pain management programme at Chedoke Hospital, Hamilton Health Sciences, Hamilton, Ontario. The test-retest reliability of the TSK-11 was 0.81 (95%CI, 0.58-0.93), the standard error of measurement was 2.41 (90%CI, 1.47-2.49), and the minimal detectible change score was 5.6. The correlation between TSK-11 and PCS at admission was 0.60 (95%CI, 0.43-0.73). The area under the ROC curve was 0.73 (95%CI, 0.57-0.88). The study results provide evidence for the test-retest reliability, cross-sectional convergent construct validity, and sensitivity to change of the TSK-11 in a population with heterogeneous chronic pain.

Self-perceived burden in chronic pain: Relevance, prevalence, and predictors

Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual’s chronic pain, none have examined patients’ perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N=238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n=80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.

Chronic Pain Management Program in a Dialysis Unit—Nephrologist & Pharmacist Collaboration

Chronic Pain Management Program in a Dialysis Unit—Nephrologist & Pharmacist Collaboration

Primary and Behavioral Healthcare Integration: Threat or Opportunity for Addiction Treatment Organizations?

Nationwide, health care systems are experiencing an increasingly rapid pace of health reforms, especially in burgeoning areas such as health homes, accountable care organizations, which emphasize the growing need for bidirectional integration of primary care and behavioral health. Several articles in this issue of the Journal of Behavioral Health Services & Research explore care that requires collaboration between primary and behavioral health: “Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments” by Lisa M Hooper et al., “Outcomes associated with a cognitive-behavioral chronic pain management program implemented in three public HIV primary care clinics” by Jodie Anne Trafton et al., and the “Relationship between neighborhood characteristics and recruitment into adolescent family-based substance use prevention programs” by Hilary F. Byrnes et al. However, is this emphasis on integration a threat or opportunity for specialty addiction treatment organizations? A recent U.S. Substance Abuse and Mental Health Services Administration–U.S. Health Resources and Services Administration Center for Integrated Health Solutions survey 1 identified a growing number of specialty addictions treatment organizations that partner with community health centers, methadone treatment centers that qualify as Federally Qualified Health Centers, and residential treatment programs that offer primary care services onsite. Even state alcohol and drug authorities are focusing on integration at annual provider meetings and state training academies. In communities, specialty addiction treatment organizations have long held relationships with primary care practices. Historically, these relationships have ensured physicals for individuals entering residential care, interim services for pregnant women and individuals using intravenous drugs, and, more recently, medication interventions as a part of addiction treatment. New integration models serve to enhance providers’ opportunities to reach individuals in earlier stages of addiction, and the earlier treatment that follows could assuage damage to their bodies and improve overall treatment outcomes. Developing recovery plans which incorporate overall health, including exercise, prevention, and specific public health goals for chronic health problems, support recovery. In terms of Screening, Brief Intervention, and Referral to Treatment (SBIRT), specialty addiction professionals fill a gap in primary care settings by supporting “referral to treatment.” Without this involvement of addiction professionals, SBIRT programs often fail when a patient requires a

A randomized controlled evaluation of an online chronic pain self management program

Internet-based educational and therapeutic programs (e-health applications) are becoming increasingly popular for a variety of psychological and physical disorders. We tested the efficacy of an online Chronic Pain Management Program, a comprehensive, fully self-directed and self-paced system that integrates social networking features and self-management tools into an interactive learning environment. Of 305 adult participants (196 women, 109 men), a total of 162 individuals with chronic pain were randomly assigned unsupervised access to the program for approximately 6 weeks; 143 were assigned to the wait-listed control group with treatment as usual. A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter. All recruitment, data collection, and participant involvement took place online. Participation was fully self-paced, permitting the evaluation of program effectiveness under real-world conditions. Intent-to-treat analysis that used linear growth models was used as the primary analytic tool. Results indicated that program utilization was associated with significant decreases in pain severity, pain-related interference and emotional burden, perceived disability, catastrophizing, and pain-induced fear. Further, program use led to significant declines in depression, anxiety, and stress. Finally, as compared to the wait-listed control group, the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management. Study limitations are considered, including the recognition that not all persons with chronic pain are necessarily good candidates for self-initiated, self-paced, interactive learning.

Outcomes Associated with a Cognitive-Behavioral Chronic Pain Management Program Implemented in Three Public HIV Primary Care Clinics

In patients with HIV/AIDS, chronic pain is common and analgesics pose serious risks. Cognitive-behavioral therapies (CBT) provide an alternative. This study evaluated feasibility and impact of a CBT-based pain management program in three public primary care clinics for HIV patients. The program included a workbook and 12-weeks of group CBT sessions. HIV-positive patients with chronic moderate to severe pain were invited to participate in the program and were assessed at enrollment, 6, 12, and 24weeks. Despite only moderate group attendance, program enrollment was associated with significant improvements in pain intensity, pain-related functioning, anxiety and acceptance, and mental health. At 24weeks, effect sizes for pain outcomes were -0.83 for pain intensity and -0.43 for functioning. The pattern of change in outcomes was consistent with predictions based on cognitive-behavioral theory. Effects were observed at all clinics. Adding CBT-based pain management into primary care may provide important benefits for patients with HIV/AIDS.

Evaluation of the online chronic pain management program

Increasingly, individuals with chronic illnesses, including pain, search the internet for health-related information and assistance. The type of available help ranges from text-based, information-only sites to custom-built software applications. The flexibility of online applications allows for the use of multimedia, as opposed to pure text-based presentation of information, user interactivity, the ability to collect, score, store, and report user data to provide a tailored user experience, inclusion of social networking such as forums and webinars, and opportunities for virtual friendships to develop. In contrast to the static nature of self-help books, CD-ROMS, or DVDs, online programs have the distinct advantage of agile modification of content and functionality. The Chronic Pain Management Program is a comprehensive, online pain management system that utilizes each of the aforementioned capabilities. Program content and functionality were derived from cognitive, behavioral, interpersonal, and self-management approaches to chronic pain management. Evidence-based approaches within these theoretical models were identified and transformed to an online format. The present study tested the efficacy of the Program with 305 individuals (196 female, 109 male) with chronic pain. A total of 162 were randomly assigned to use the Program; 143 to the wait list control group. A comprehensive assessment was administered prior to the study, and at approximately 7 and 14 weeks. All data collection and participant involvement took place online. Intent-to-treat analysis was employed using linear growth models as the primary analytic tool for the study. Results indicated that utilization of the Program was associated with significant decreases in pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing, and pain induced fear. Further, the experimental group displayed significant reductions in stress, anxiety, and depression, as well as increased knowledge about the principles of chronic pain and its management. Supported by grants from the National Institute of Neurological Disorders and Stroke. Increasingly, individuals with chronic illnesses, including pain, search the internet for health-related information and assistance. The type of available help ranges from text-based, information-only sites to custom-built software applications. The flexibility of online applications allows for the use of multimedia, as opposed to pure text-based presentation of information, user interactivity, the ability to collect, score, store, and report user data to provide a tailored user experience, inclusion of social networking such as forums and webinars, and opportunities for virtual friendships to develop. In contrast to the static nature of self-help books, CD-ROMS, or DVDs, online programs have the distinct advantage of agile modification of content and functionality. The Chronic Pain Management Program is a comprehensive, online pain management system that utilizes each of the aforementioned capabilities. Program content and functionality were derived from cognitive, behavioral, interpersonal, and self-management approaches to chronic pain management. Evidence-based approaches within these theoretical models were identified and transformed to an online format. The present study tested the efficacy of the Program with 305 individuals (196 female, 109 male) with chronic pain. A total of 162 were randomly assigned to use the Program; 143 to the wait list control group. A comprehensive assessment was administered prior to the study, and at approximately 7 and 14 weeks. All data collection and participant involvement took place online. Intent-to-treat analysis was employed using linear growth models as the primary analytic tool for the study. Results indicated that utilization of the Program was associated with significant decreases in pain severity, pain-related interference, emotional burden, perceived disability, catastrophizing, and pain induced fear. Further, the experimental group displayed significant reductions in stress, anxiety, and depression, as well as increased knowledge about the principles of chronic pain and its management. Supported by grants from the National Institute of Neurological Disorders and Stroke.

Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa

Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A Chronic Pain Management Programme (CPMP) based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14) were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups.

Does Classification of Persons with Fibromyalgia into Multidimensional Pain Inventory Subgroups Detect Differences in Outcome after a Standard Chronic Pain Management Program?

The present study aimed to replicate and validate the empirically derived subgroup classification based on the Multidimensional Pain Inventory (MPI) in a sample of highly disabled fibromyalgia (FM) patients. Second, it examined how the identified subgroups differed in their response to an intensive, interdisciplinary inpatient pain management program. Participants were 118 persons with FM who experienced persistent pain and were disabled. Subgroup classification was conducted by cluster analysis using MPI subscale scores at entry to the program. At program entry and discharge, participants completed the MPI, Medical Outcomes Study Short Form-36, Hospital Anxiety and Depression Scale and Coping Strategies Questionnaire. Cluster analysis identified three subgroups in the highly disabled sample that were similar to those described by other studies using less disabled samples of FM. The dysfunctional subgroup (DYS; 36% of the sample) showed the highest level of depression, the interpersonally distressed subgroup (ID; 24%) showed a modest level of depression and the adaptive copers subgroup (AC; 38%) showed the lowest depression scores in the MPI (negative mood), Medical Outcomes Study Short Form-36 (mental health), Hospital Anxiety and Depression Scale (depression) and Coping Strategies Questionnaire (catastrophizing). Significant differences in treatment outcome were observed among the three subgroups in terms of reduction of pain severity (as assessed using the MPI). The effect sizes were 1.42 for DYS, 1.32 for AC and 0.62 for ID (P=0.004 for pairwise comparison of ID-AC and P=0.018 for ID-DYS). These findings underscore the importance of assessing individuals' differences in how they adjust to FM.

Learned Resourcefulness and the Long-Term Benefits of a Chronic Pain Management Program

A concurrent mixed methods approach was used to understand how learned resourcefulness empowers individuals. After completing Rosenbaum's Self-Control Schedule (SCS) measuring resourcefulness, 16 past clients of a multimodal pain clinic were interviewed about the kinds of pain-coping strategies they were practicing from the program. Constant comparative analysis of the text-based data revealed striking differences in the type of pain management strategies used by high- and low-resourceful participants. A substantive theory is advanced, whereby introspection and emotion allow for acceptance, which in turn permits the constructive use of social supports and enactment of active, and sometimes creative, pain-coping strategies to engage in meaningful activities.

Does Systematic Graded Exposure In Vivo Enhance Outcomes in Multidisciplinary Chronic Pain Management Groups?

Graded exposure in vivo (GEXP) treatment has been successfully used to reduce levels of pain-related fear and disability in some chronic pain patients, but its effectiveness has not been evaluated in general clinical settings using group-design studies. The purpose of this study was to determine if the systematic incorporation of GEXP into a multidisciplinary chronic pain management group (PMG) treatment program would result in better treatment outcomes than usual PMG treatment. One hundred forty-three chronic pain patients who were assessed as suitable for an outpatient multidisciplinary chronic PMG program were randomly allocated to 3 experimental conditions; usual PMG, PMG incorporating systematic graded exposure, and wait-list control. The clinical outcomes of the 2 treatment conditions were not significantly different, suggesting that the systematic incorporation of GEXP into a multidisciplinary PMG program did not result in better treatment outcomes than usual PMG treatment. Both group treatment programs were associated with significant treatment effects when compared with the wait-list control on measures of pain intensity, fear of movement/(re)injury, pain self-efficacy, activity level, and depression. No treatment effects were found on self-report measures of pain disability or anxiety. The addition of systematic graded exposure into a multidisciplinary chronic pain management program did not result in better clinical outcomes than the usual group treatment program. The validity of GEXP to the broader population of chronic pain patients warrants further investigation.

Examining the Pain Stages of Change Questionnaire in Chronic Pain

Purpose: This study examined the relationships of a readiness to adopt a self-management approach to chronic pain, measured by the Pain Stages of Change Questionnaire (PSOCQ), with other pain-related scales in patients attending a chronic pain management program and determined if these measures changed from admission to discharge. The PSOCQ consists of four stages: Pre-contemplation, Contemplation, Action and Maintenance. Method: A convenience sample of 140 patients (mean age = 43.8 years; SD = 8.3 years) with chronic pain completed the PSOCQ, the Pain Disability Index (PDI), the Pain Intensity Scale (PIS), the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Multidimensional Health Locus of Control Scale (MHLC) at admission and discharge. The MHLC consists of three subscales: Internal, Chance and Powerful Others. Results: At discharge, Pearson correlation coefficients demonstrated that Pre-contemplation was positively associated with the PDI, the PIS and the CES-D and negatively associated with Internal MHLC, whereas Action and Maintenance showed the opposite findings. There were significant improvements in all measures, except the MHLC, over the four-week program. Conclusions: These findings provide support for the use of the PSOCQ in assessing patients' readiness to adopt a self-management approach to pain and in monitoring their progress in rehabilitation.

A Triage Approach to Managing a Two Year Wait‐List in a Chronic Pain Program

Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed. All referrals to the Queen Elizabeth II Health Sciences Centre's Pain Management Unit for a one-year period were reviewed and triaged as either 'regular waiting list' or 'fast track'. Patients in the fast track group were seen within four months and required limited interventions or were urgent in nature. The regular waiting list group waited up to 27 months for assessment and development of a treatment plan. Treatment recommendations were faxed to the referring physician. A follow-up questionnaire was sent to each physician to assess whether these treatment recommendations were useful. Recommendations were faxed for 297 patients. One hundred forty-nine physicians returned the follow-up questionnaire. Ninety-five physicians used the recommendations and 68 patients followed the recommendations. Seventy-nine physicians felt that the recommendations were helpful to them in their care of the patient. For 39 patients, the recommendations were helpful. The most frequently used recommendations were those on medications (eg, tricylic antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs and controlled-release opioids). Other modalities included participation in an interdisciplinary group program and physiotherapy. A triage review process with recommendations faxed to referring physicians was developed and put into action for one year. The recommendations were used by 32% of the physicians (64% of responding physicians). Fifty-three per cent of responding physicians felt that the recommendations were helpful in the care of their patient. This process led to a benefit in care, as perceived by the physician, in 26% of patients (of physicians who returned the questionnaire [13% of all patients]) on the waiting list for a tertiary care pain management unit.

Cognitive/behavioral approaches: Readiness to adopt a self-management approach to chronic pain and treatment outcomes

The Pain Stages Of Change Questionnaire (Kerns RD, et al., Pain, 1997) measures readiness to adopt a self-management approach to chronic pain. Such an approach is considered necessary for chronic pain patients to engage in interdisciplinary cognitive-behavioral chronic pain management programs and produce successful outcomes. The PSOCQ consists of four factors: Precontemplation, Contemplation, Action and Maintenance. In this study, 100 chronic pain patients enrolled in a four-week interdisciplinary pain management program will be administered a “program evaluation” package of questionnaires at admission and discharge from the program. This package contains the PSOCQ and several other validated psychometric scales measuring pain intensity, pain-related disability, depression, health locus of control, goal accomplishment and program satisfaction. (The latter two scales are administered at discharge). The purpose of this study (ongoing) is to examine the relationships between readiness to adopt a self-management approach to chronic pain, as measured by the PSCQ, and pain management program outcomes. Typical outcomes in this program are reduced pain level and pain-related interference / improved functional status, improved mood, “good” goal accomplishment as reported by the patients, and program satisfaction. These findings largely support those of the general literature on chronic pain management outcomes. Preliminary results from the first 35 patients show that successful pain management outcomes correspond with increases in the “Action” and “Maintenance” components of the PSOCQ. It is also observed that these components themselves show substantial increases at discharge. The implications of these findings for pain management outcome will be discussed within the context of the literature on the PSOCQ and attempts to identify pre-treatment patient indicators predictive of success of chronic pain management programs. The Pain Stages Of Change Questionnaire (Kerns RD, et al., Pain, 1997) measures readiness to adopt a self-management approach to chronic pain. Such an approach is considered necessary for chronic pain patients to engage in interdisciplinary cognitive-behavioral chronic pain management programs and produce successful outcomes. The PSOCQ consists of four factors: Precontemplation, Contemplation, Action and Maintenance. In this study, 100 chronic pain patients enrolled in a four-week interdisciplinary pain management program will be administered a “program evaluation” package of questionnaires at admission and discharge from the program. This package contains the PSOCQ and several other validated psychometric scales measuring pain intensity, pain-related disability, depression, health locus of control, goal accomplishment and program satisfaction. (The latter two scales are administered at discharge). The purpose of this study (ongoing) is to examine the relationships between readiness to adopt a self-management approach to chronic pain, as measured by the PSCQ, and pain management program outcomes. Typical outcomes in this program are reduced pain level and pain-related interference / improved functional status, improved mood, “good” goal accomplishment as reported by the patients, and program satisfaction. These findings largely support those of the general literature on chronic pain management outcomes. Preliminary results from the first 35 patients show that successful pain management outcomes correspond with increases in the “Action” and “Maintenance” components of the PSOCQ. It is also observed that these components themselves show substantial increases at discharge. The implications of these findings for pain management outcome will be discussed within the context of the literature on the PSOCQ and attempts to identify pre-treatment patient indicators predictive of success of chronic pain management programs.