• Paul R Falzer, Howard L Leventhal, Ellen Peters, Terri R Fried, Robert Kerns, Marion Michalski, and Liana Fraenkel.
• Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA. paul.falzer@yale.edu
• Pain Pract. 2013 Mar 1; 13 (3): 215-26.

ObjectiveThis study describes how pain practitioners can elicit the beliefs that are responsible for patients' judgments against considering a treatment change and activate collaborative decision making.MethodsBeliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient's life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment.ResultsWhile only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long-term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor.ConclusionInitial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients' current conditions. These beliefs can be elicited through dialog by asking 3 questions.© 2012 The Authors. Pain Practice © 2012 World Institute of Pain.

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