• Clin J Pain · Mar 2020

    Comment Letter

    Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients: Long-Term Predictive Validity of Pre- and Post-Treatment Change Scores and Stability of Post-Treatment Scores.

    • Chung Jung Mun, John D Otis, John Concato, M Carringotn Reid, Matthew M Burg, Rebecca Czlapinski, and Robert D Kerns.
    • Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine Baltimore, MD.
    • Clin J Pain. 2020 Mar 1; 36 (3): 227227.

    Objectives: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 pre- and post-treatment PSOCQ change scores among chronic low back pain patients could predict six and twelve-month follow-up outcomes, and the stability of post-treatment PSOCQ scores during follow-up.Methods:Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (i.e., PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pre-treatment, 10 weeks post-treatment, 6-month follow-up, and 12-month follow-up assessments.Results:Multiple regression analyses showed that pre- and post-treatment 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. Post-treatment Pre-contemplation and Action/Maintenance scores were quite stable, even at 12-month follow up.Conclusions: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.

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