Pain Stages Of Change Questionnaire Research Articles

Readiness to Change Among Adolescents with Chronic Pain and Their Parents: Is the German Version of the Pain Stages of Change Questionnaire a Useful Tool?

The Pain Stages of Change Questionnaire (PSOCQ) measures patients’ willingness to engage in active self-management of their pain. The present study aimed to create validated German short versions of the PSOCQ for adolescents (PSOCQ-A) and their parents (PSOCQ-P). Additionally, an investigation of stages of change regarding pain characteristics and treatment outcomes was undertaken. In Study 1, the data of adolescents aged 11 to 18 years and their parents were collected prior to intake (N = 501) and at admission (N = 240) to specialist inpatient pain treatment. Confirmatory factor analyses indicated a poor fit of the full PSOCQ measures prior to intake, but an acceptable fit at admission. Short PSOCQ-A and PSOCQ-P versions were identified. In Study 2, these results were cross-validated with data from an additional N = 150 patients and their parents, collected during and 3 months after interdisciplinary inpatient pain treatment. Model fits for both short versions were acceptable, although low internal consistency for the PSOCQ-A Precontemplation and Contemplation subscales was identified. During treatment, both patients’ and their parents’ readiness to change increased. Stage of change at discharge did not predict treatment non-response 3 months later. This study indicates that the PSOCQ is neither meaningful prior to admission nor predictive of non-response to treatment. While some value may exist in monitoring treatment progress, based on the results of this study, it is not recommended that the PSOCQ-A and PSOCQ-P be used as a measure of stage of change in German pediatric pain populations.

Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients: Long-term Predictive Validity of Pretreatment and Posttreatment Change Scores and Stability of Posttreatment Scores.

In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients' readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back pain patients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up. Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments. Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up. Changes in patients' attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.

Readiness to change as a moderator of therapy outcome in patients with somatoform disorders

Objective: A considerable amount of patients with somatoform disorders do not benefit from psychotherapy as much as expected. Our aim was to explore whether readiness to change moderates the relationship between the intensity of symptoms and therapy outcome in the early stages of psychotherapy. Method: 144 patients with somatoform disorders received an outpatient cognitive-behavioural intervention. Symptom intensity was measured with the Screening for Somatoform Disorders (SOMS-7). For readiness to change, a German modification of the Pain Stages of Change Questionnaire (PSOCQ) was used, which comprises four subscales (FF-STABS). Regression analyses were carried out, with baseline symptoms and the readiness to change subscales as predictors and symptom reduction as the outcome variable. Results: Moderation analyses revealed significant interaction effects between baseline symptoms and the precontemplation subscale, as well as between baseline symptoms and the action subscale. For preparation and maintenance, no significant interaction effects were found. Conclusions: The results suggest that readiness to change is a variable that can be used to differentiate between patients, with low precontemplation and action scores indicating a better chance for positive outcome, even with high initial impairment. Rather than using readiness to change sum scores, the sub-aspects of this construct should be the subject of future research.

The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program

To assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy. Children with fibromyalgia seen at a tertiary care hospital were treated with 5-6 hours of intensive PT/OT daily and at least 4 hours of psychosocial services weekly. All medications used for fibromyalgia were discontinued. Children underwent standardized testing, including a visual analog scale for pain; the Bruininks-Oseretsky Test of Motor Performance, Second Edition; the Bruce treadmill protocol; the Functional Disability Inventory; the Pain Stages of Change Questionnaire, adolescent version; and the Pediatric Quality of Life Inventory, Teen Report, at 3 time points: at program entry, at the end of the intensive program, and 1 year after the end of the program. Sixty-four children (median age, 16 years; 95% Caucasian; 94% female; median duration of symptoms, 21 months) were studied. The mean pain score decreased significantly from program entry to the end of the program (from 66 of 100 to 25 of 100; P = .001). At the 1-year follow-up, 33% reported no pain. All measures of function on the Bruininks-Oseretsky Test of Motor Performance, Second Edition improved significantly and remained at that level or continued to improve over the subsequent year. The mean Bruce treadmill protocol time first increased from 588 seconds to 801 seconds (P < .001) and then dropped to 750 seconds (P = .005), which is at the 90th percentile for age and sex. All Pain Stages of Change Questionnaire, adolescent version subset scores improved significantly initially and were stable or improved at 1 year, as did the Pediatric Quality of Life Inventory, Teen Report total score. Children with fibromyalgia can be successfully treated without medications with a very intensive PT/OT and psychotherapy program. They have significantly improved pain and function by subject report and objective measures of function.

Development of the Italian version of the Pain Stages of Change Questionnaire in patients with chronic low back pain

Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward-backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach's α) and test-retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (Pearson's correlation). The questionnaire was administered to 308 patients with chronic low back pain. Factor analysis confirmed a four-factor solution (namely, Precontemplation, Contemplation, Action, and Maintenance), achieving an acceptable data-model fit. Internal consistency (α=0.91-93) and test-retest reliability (intraclass coefficient correlation=0.74-0.81) were satisfactory. Construct validity showed moderate correlations between Precontemplation and PCS (r=0.318), TSK (r=0.385), RMDQ (r=0.320) and NRS (r=0.335); low correlations were found between the other PSOCQ subscales and PCS (r=-0.062; 0.039), TSK (r=-0.164; 0.024), RMDQ (r=-0.073; 0.004) and NRS (r=-0.170; 0.020). Low correlations were found between the PSOCQ-I subscales and anxiety (r=-0.132; 0.150) and depression (r=-0.113; 0.186). The PSOCQ was translated successfully into Italian, and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purposes.

Psychometric properties of the pain stages of change questionnaire as evaluated by rasch analysis in patients with chronic musculoskeletal pain

BackgroundOur objective was to evaluate the measurement properties of the Pain Stages of Change Questionnaire (PSOCQ) and its four subscales Precontemplation, Contemplation, Action and Maintenance.MethodsA total of 231 patients, median age 42 years, with chronic musculoskeletal pain responded to the 30 items in PSOCQ. Thresholds for item scores, and unidimensionality and invariance of the PSOCQ and its four subscales were evaluated by Rasch analysis, partial credit model.ResultsThe items had disordered threshold and needed to be rescored. The 30 items in the PSOCQ did not fit the Rasch model Chi- square item trait statistics. All subscales fitted the Rasch models. The associations to pain (11 point numeric rating scale), emotional distress (Hopkins symptom check list v 25) and self-efficacy (Arthritis Self-Efficacy Scale) were highest for the Precontemplation subscale.ConclusionThe present analysis revealed that all four subscales in PSOCQ fitted the Rasch model. No common construct for all subscales were identified, but the Action and Maintenance subscales were closely related.

Evaluation of an Interdisciplinary Program for Chronic Pain After Spinal Cord Injury

To assess efficacy of an interdisciplinary pain program adapted for persons with spinal cord injury (SCI) and chronic pain. Prospective cohort. University-affiliated rehabilitation hospital. Twenty-two persons with traumatic or nontraumatic SCI and chronic pain of at least 6 months' duration. Subjects participated in an interdisciplinary pain program consisting of biweekly group sessions for 10 consecutive weeks. Sessions incorporated patient education on chronic pain and associated pain mechanisms, cognitive behavioral therapy, self-management strategies (eg, energy conservation, ergonomics, goal setting, stress management, anger management, and coping skills), group discussions and activities, and either exercise or guided relaxation at the end of each session. Multidimensional Pain Inventory SCI, Coping Inventory of Stressful Situations, Pain Stages of Change Questionnaire, and Life Satisfaction Questionnaire. After participation in an interdisciplinary pain program, persons with SCI and chronic neuropathic pain demonstrated increased involvement in learning and maintenance of coping strategies for chronic pain. Participation also led to less pain interference in daily life and a greater sense of control over one's life. Participation in an interdisciplinary pain program does not reduce pain severity, but it can help persons with SCI and chronic neuropathic pain cope with pain, lessen interference of pain, and improve their sense of control.

PC-FACS

PC-FACS

Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program

The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. A total of 157 children ages 10 to 18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pretreatment, posttreatment, and short-term follow-up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children’s readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents’ readiness to adopt a pain self-management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pretreatment willingness to self-manage pain and posttreatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being.

Randomized trial of a DVD intervention to improve readiness to self-manage joint pain

A DVD (digital video disk) intervention to increase readiness to self-manage joint pain secondary to hemophilia was informed by a 2-phase, motivational-volitional model of readiness to self-manage pain, and featured the personal experiences of individuals with hemophilia. The DVD was evaluated in a randomized controlled trial in which 108 men with hemophilia completed measures of readiness to self-manage pain (Pain Stages of Change Questionnaire) before and 6 months after receiving the DVD plus information booklet (n=57) or just the booklet (n=51). The effect of the DVD was assessed by comparing changes in Pain Stages of Change Questionnaire scores (precontemplation, contemplation, and action/maintenance) between groups. The impact on pain coping, pain acceptance, and health-related quality of life was tested in secondary analyses. Repeated-measures analysis of variance, including all those with complete baseline and follow-up data regardless of use of the intervention, showed a significant, medium-sized, group×time effect on precontemplation, with reductions among the DVD group but not the booklet group. Significant use×time effects showed that benefits in terms of contemplation and action/maintenance were restricted to those who used the interventions at least once. The results show that low-intensity interventions in DVD format can improve the motivational impact of written information, and could be used to help prepare people with chronic pain for more intensive self-management interventions. The findings are consistent with a 2-phase, motivational-volitional model of pain self-management, and provide the first insights to our knowledge of readiness to self-manage pain in hemophilia.

Readiness to change in pediatric chronic pain: Initial validation of adolescent and parent versions of the Pain Stages of Change Questionnaire

Despite the clinical importance of readiness to change in predicting treatment outcomes among adults, no studies have examined this construct among pediatric pain patients. Because parents play a key role in adolescent pain management, both adolescent and parent readiness to adopt a self-management approach to pain merit further study. The primary goal of the current study was to validate adolescent and parent-report adaptations of the adult Pain Stages of Change Questionnaire (PSOCQ). Participants included 259 adolescent patients with chronic pain syndromes and their parents presenting to 2 pediatric pain management clinics. Using confirmatory factor analytic techniques, a 4-factor solution was supported for the parent version (PSOCQ-P) that included Precontemplation, Contemplation, Action, and Maintenance factors, whereas the adolescent version (PSOCQ-A) version supported a three-factor model that combines the Action and Maintenance scales. Within both versions, each of the factors was found to be internally consistent. The PSOCQ-A and PSOCQ-P showed evidence of criterion validity through significant correlations with coping strategies and pain catastrophizing. Stability findings at 4 and 8weeks after a multidisciplinary pain clinic evaluation are reported. Associations between pediatric PSOCQ scores and demographic, pain, and functional domains were explored to inform future research. Further validation of the PSOCQ-A and PSOCQ-P measures with new, separate samples of pediatric pain patients and parents are needed before use in clinical contexts.

Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident

Previous research has found pre-treatment motivational readiness to engage in pain self-management to be associated with completion of a rehabilitation program. This preliminary study examined this relationship, as well as the ability of pre-treatment readiness to change to predict clinical decisions of post-treatment functional work capacity. The sample consisted of 106 individuals involved in a tertiary functional rehabilitation program for motor vehicle accident (MVA) survivors. The Multidimensional Pain Inventory (MPI) and Pain Stages of Change Questionnaire (PSOCQ) were completed prior to treatment. Hierarchical logistic regression analyses revealed that PSOCQ profile scores (P = 0.008), including higher individual PSOCQ contemplation (OR = 5.30; P = 0.017) and action (OR = 5.16; P = 0.049) scores, significantly increased the likelihood of completing the functional rehabilitation program. Clinical decisions about functional work capacity were predicted by MPI profile scores (P = 0.001), and this model was significantly improved by the addition of PSOCQ scores (P = 0.037). Lower MPI interference (OR = 5.41; P = 0.002), and higher MPI affective distress (OR = 2.81; P = 0.010), MPI support (OR = 1.72; P = 0.027), and PSOCQ action (OR = 5.35; P = 0.038) scores were significant predictors of clinicians' decisions regarding functional work capacity in the final model that identified 88% of those judged capable of returning to work and 63% of those who were judged not capable of returning to work. This preliminary study suggests that readiness to self-manage pain is an important predictor of both completion of functional rehabilitation program and clinicians' decisions regarding functional work capacity after an MVA. The latter outcome appears to be more complex, influenced both by motivational readiness to engage in pain self-management and cognitive-behavioral adaptation to pain.

The Relationship Between the Readiness for Change and Clinical Outcomes in Response to Multidisciplinary Pain Management

The pain stages of change questionnaire (PSOCQ) has been designed to assess the willingness of chronic pain patients to engage in self-management approaches. This study sought to examine the utility of the PSOCQ as a predictor of treatment completion and the relationship with treatment outcome. A convenience sample, uncontrolled, pre- and post-intervention cohort design. Multidisciplinary pain management center. Two hundred and sixty-one participants with chronic nonmalignant pain. Eight-week program of either cognitive behavioral therapy group or a functional restoration group. Brief Pain Inventory average pain rating. The Short Form Health Survey (SF-36 version 2) mental health and physical functioning subscales as well as the PSOCQ. Results suggest that those higher on precontemplation and lower on the other scales are less likely to complete treatment. A two-way multiple analysis of variance also found that when comparing those who progress through stages with those who stagnate or regress, "progressors" show significantly more improvement in measures of mood and functionality but not pain. The treatment groups did not appear to have significantly different outcomes in terms of stage of change. These findings suggest that the PSOCQ may be useful in making treatment more efficient, both by predicting who is less likely complete treatment and by providing targeted treatments according to patients' readiness to engage in self-management.

Readiness to adopt a self-management approach to pain – Are profiles of subscale scores on the Pain Stages of Change Questionnaire useful?

The study evaluated the ability of the Pain Stages of Change Questionnaire (PSOCQ) to classify subjects into specific profiles of readiness to adopt a self-management approach to pain. An analysis was made of whether the five earlier described PSOCQ-profiles Precontemplation, Contemplation, Non-contemplative Action, Participation and Ambivalent could be reproduced by two different methods, cluster analysis and visual analysis. The 184 included subjects completed the PSOCQ, the Hopkins Symptom Checklist (HSCL-25), the Tampa scale of Kinesiophobia (TSK) and five self-efficacy questions from the arthritis self-efficacy questionnaire (ASES). Profiles were drawn based on the mean scores of the four subscales in PSOCQ. All the five predefined profiles were identified visually by two coders with an interrater agreement of Kappa 0.731. A 6-cluster solution generated the four profiles Precontemplation, Contemplation, Non-contemplative Action and Participation. Discriminant function analysis (DFA) on cluster analysis classified 83.5% of cases in the same group, and DFA on visual classification 72.1% of cases. Fifty-three percent were classified in the same profile by cluster and visual analysis. The two profiles Precontemplation and Participation seem to identify distinct subgroups that differ in educational level, pain during activity and psychometric measures. Non-contemplative Action share characteristics with Precontemplation, and the Contemplation group has scores in between. In conclusion, more research on the validity of the PSOCQ is needed. Outcome studies after pain treatment programmes could focus three main states that differ on measures for concurrent validity: Profiles that can be identified as Precontemplation or Non-contemplative action, Contemplators, and subjects with Participation profiles.

The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change—A non-randomized controlled study

Background Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted. Objectives The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ). Design A pretest–post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used. Setting The study was conducted in the rehabilitation unit of a university hospital. Participants Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18–67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment. Methods The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered. Results The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance. Conclusions Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective treatment results are about identifying and addressing the important and changeable influences maintaining pain problems such as acceptance, understanding the mind-body connection and self-management. Although further research is needed to evaluate the effectiveness of this work, such group approaches appear to represent a feasible treatment option for many patients with chronic pain.

Patienten mit Fibromyalgiesyndrom: Der Einfluss von Depressivität auf die Einstellung zur Schmerzbewältigung

The aim of this study was to investigate how depressiveness affects coping of patients with fibromyalgia. It was assumed that depressiveness has an influence on coping, self-efficacy und motivation for therapy. A total of 251 patients with fibromyalgia. The investigation started at the outset of their stay in the clinic, and both patients with and without depressiveness (HADS-D cut-off >or=11) were examined. To investigate the differences, multivariate variance models were used for cognitive and behavioural coping, self-efficacy and motivation for therapy. Data were collected using the Hospital Anxiety and Depression Scale (HADS-D), German pain questionnaire (DSF), Questionnaire for assessment of level of coping with pain (FESV) and the German version of the Pain stages of change questionnaires (FF-STABS). Comparison of the groups shows significantly lower means for the fibromyalgia patients with depressive symptoms concerning "perceived self-competence", "cognitive restructuring", and "countertraded activity". The same results can be observed for "self-efficacy". Analysis of the motivation for therapy in the "carefreeness" scale shows significantly higher means in the fibromyalgia patients with depressive symptoms. In the "maintenance" scale, however, lower means are observed in this patient group. As fibromyalgia patients with depressive symptoms show greater strain on account of their psychosomatic symptoms, depressive symptoms should be dealt with during treatment.

Two Brief Versions of the Multidimensional Pain Readiness to Change Questionnaire, Version 2 (MPRCQ2)

The present study sought to develop 1-item and 2-item versions of subscales from the Multidimensional Pain Readiness to Change Questionnaire, Version 2 (MPRCQ2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. One hundred and ninety patients with rheumatic diseases who entered a Rheumatology Day Program completed the MPRCQ2 and an additional criterion measure, the Pain Stages of Change Questionnaire (PSOCQ), before and after treatment. First one and then a second item that best represented each MPRCQ2 scale were selected based on: (1) the correlations between the items and their parent MPRCQ2 scale; (2) responsivity to change following treatment; (3) correlations of the items with the PSOCQ scales; and (4) authors' consensus of face validity and construct representativeness of items. The psychometric properties of the 1-item and 2-item versions of the MPRCQ2 scales were then examined. These brief versions provided good approximations of their parent scales and 9/10 were responsive to change following multidisciplinary treatment. Correlations between the brief scales and the PSOCQ scales showed similar relationships as with the full MPRCQ2 scales. The findings support the validity of these brief versions of the MPRCQ2 subscales. We would recommend the use of these versions of the MPRCQ2 when a measure of patient readiness to use a range of pain self-management coping strategies is needed (eg, treatment process research, prediction of success in multidisciplinary treatment), but response burden is a significant issue.

Schmerzbewältigung und psychische Beeinträchtigung durch chronische Schmerzen bei Patienten mit rheumatischen Erkrankungen: zur Aussagekraft des Transtheoretischen Modells (TTM)

Hintergrund: Die Bereitschaft zur Einstellungs- und Verhaltensänderung bildet eine wichtige Voraussetzung für die Bewältigung chronischer Schmerzen bei rheumatischen Erkrankungen. Durch die Stadien Absichtslosigkeit, Vorbereitung, Handlung und Aufrechterhaltung wird im Transtheoretischen Modell (TTM) die Veränderungsbereitschaft beschrieben. Es wird die Frage geklärt, ob ein bedeutender positiver Zusammenhang zwischen der Bereitschaft zur Verhaltens- und Einstellungsänderung und der Fähigkeit zur Schmerzbewältigung besteht. Methodik: Es wurden 147 Patienten einer rheumatologischen Rehabilitationsklinik im Hinblick auf ihre Veränderungsmotivation mit dem Freiburger Fragebogen – Stadien der Bewältigung chronischer Schmerzen (FF-STABS) – befragt. Dabei konnten die Daten von 134 Patienten in die Analyse einbezogen werden. Die behaviorale und kognitive Schmerzbewältigung sowie die psychische Beeinträchtigung wurden mit dem Fragebogen zur Erfassung der Schmerzverarbeitung (FESV) erhoben. Durch Varianzanalysen (SPSS-Prozedur GLM) wurden die Unterschiede der TTM-Stadien in Bezug auf die Schmerzbewältigung und psychische Beeinträchtigung untersucht. Ergebnisse und Schlussfolgerungen: Der multivariate Haupteffekt des Motivationsstadiums zeigt einen signifikanten Unterschied der Schmerzbewältigung für die vier Stadien des Transtheoretischen Modells (p = 0,003; F = 1,969). Patienten in einem höheren Motivationsstadium zeigen somit eine angemessene Schmerzbewältigung und eine geringere psychische Beeinträchtigung. Dies lässt sich ebenso für die Post-Hoc-Tests der Subskalen des FESV zeigen (z. B. Kompetenzerleben p = 0,001; F = 5,602).

(343) Adolescent and parent pain beliefs and readiness to change in the context of an initial multidisciplinary pain clinic consultation: Preliminary findings

Chronic and recurrent pediatric pain brings significant medical, emotional, social, and economic consequences for children, adolescents, and their families. Parents play a vital role in seeking health related services and a biopsychosocial perspective of pain appears to be an important factor in the resolution of chronic pediatric pain. Health related beliefs and treatment expectations are associated with the degree to which adult patients seek help, adhere to treatment recommendations and/or become disabled. However, little is known about the pain-related beliefs and expectations that pediatric patients and their families have regarding chronic pain treatment and how this may relate to treatment course. To date we have enrolled N=6 adolescent-parent dyads in a project examining pain-related beliefs and treatment expectations as they relate to short term outcomes including pain, disability, and nonadherence among adolescents with chronic, non-disease specific musculoskeletal pain within the context of an outpatient multidisciplinary pain clinic. We will present findings from approximately N=30 adolescent-parent dyads pertaining to reports of pain threat beliefs and readiness to change at the time of the initial clinic visit. We hypothesize that beliefs of greater pain threat, as assessed by the Pain Catastrophizing Scale for Children and Parents (PCS-C, -P), will be correlated with greater readiness to change, as assessed by Pain Stages of Change Questionnaire for Children (PSOCQ-C) precontemplation scale, for both adolescents and parents. We further hypothesize that greater PSOCQ-C action and PSOCQ-C maintenance scale scores will be correlated with stronger agreement with a biopsychosocial perspective of pain. Demographic characteristics of the sample, descriptive information related to study measures, Pearson correlations, and Kappa statistics will be presented. Findings will be considered with respect to our broader aim of better understanding adolescent and parent factors that may facilitate or impede treatment progress.

Welche Rolle spielt die Veränderungsmotivation des Transtheoretischen Modells (TTM) für das Ausmaß der Beeinträchtigung durch chronische Schmerzen bei Patienten mit rheumatischen Erkrankungen?

BACKGROUND: Motivation in the concept of the Transtheoretical Model (TTM) is the readiness to make a change of attitudes and behaviour and is essential for effective self-management of chronic pain. According to this patients pass through different stages of change (precontemplation, preparation, action, maintenance) before they adopt a new behaviour (e. g., relaxation exercise). The present study evaluates how the four stages of change differ in terms of pain variables in patients with chronic pain. METHODS: Different questionnaires (pain disability in social, family and job-related domains, self-efficacy expectations and the German version of the Pain Stages of Change Questionnaires (PSOCQ), the FF-STABS were administered two times to 147 patients of a rehabilitation clinic. Statistical analysis of variance (SPSS-procedure GLM) was used to analyse the relevance of the stages of change for pain variables. RESULTS: The main effect of the multivariate analysis of variance shows significant differences between the four stages of change for the dimension pain disability (p = 0.001; F = 2.422; df = 21). Pain-related self-efficacy was increased in higher stages (p = 0.003; F = 4.903; df = 3). Via post-hoc tests the stage of change maintenance differed significantly in contrast to precontemplation, preparation and action in terms of pain disability in social, family and job-related domains. Further studies are recommended to investigate the validity of the stages of change model with respect to other pain-related dimensions, because the stages precontemplation, preparation and action could not always distinguished precisely.