Margaret Caudill

Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.

To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. Questionnaires from 126 chronic pain patients (without prior depression) were reviewed from three pain clinics. Hypothesized and alternate models were tested using separate regression equations to identified models which best fit these data. Regression analysis supported that self efficacy partially mediates the relationship between pain intensity and disability. This model accounted for 47% of the explained variance in disability (P < 0.001). Six additional variables that were significantly related to disability in preliminary analysis, added to the explained variance in disability (R2 = 0.56), with gender and pain location paths remaining significant. In separate regression analyses, disability was found to partially mediate the relationship between pain intensity and depression (b = 0.47-0.33). This model accounted for 26% of the explained variance in depression. The addition of self efficacy to this model supported it as a stronger mediator (R2 = 0.32), and suggested that support for disability as a mediator of depression was a spurious finding. Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain. Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.

Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ)

Abstract This manuscript describes the development and initial validation of a self‐report questionnaire designed to assess an individuals readiness to adopt a self‐management approach to their chronic pain condition. Theory and preliminary empirical work informed the development of a pool of items that were administered to a sample of individuals reporting chronic pain. Analyses of the data support a four factor measure that is consistent with the transtheoretical model of change and associated stages of change model. Each of the four factors, precontemplation, contemplation, action, and maintenance, was found to be internally consistent and stable over time. There was also substantial support for each factors discriminant and criterion‐related validity.

Decreased clinic use by chronic pain patients : response to behavioral medicine intervention

The treatment of chronic pain is costly and frustrating for the patient, health care provider, and health care system. This is due, in part, to the complexity of pain symptoms which are influenced by behavior patterns, socioeconomic factors, belief systems, and family dynamics as well as by physiological and mechanical components. Assessment of treatment outcomes is often limited to the patients subjective, multidimensional, self-reports. Outcome measures based on data about return to work or clinic use can provide more objective assessments of intervention benefits. In this study, a 36% reduction in clinic visits in the first year postintervention was found among the 109 patients who participated in an outpatient behavioral medicine program. Decreased clinic use continued in the first 50 patients followed 2 years postintervention. Decreased use projected to an estimated net savings of

An inventory of positive psychological attitudes with potential relevance to health outcomes : validation and preliminary testing

12,000 for the first year of the study posttreatment and

DECREASED CLINIC UTILIZATION BY CHRONIC PAIN PATIENTS AFTER BEHAVIORAL MEDICINE INTERVENTION

23,000 for the second year.

Behavioral medicine, clinical health psychology, and cost offset.

This article describes the validation of an Inventory of Positive Psychological Attitudes that has potential relevance to health outcomes and its preliminary testing with chronic pain patients. The inventory taps two attitudinal domains: (1) life purpose and satisfaction and (2) self-confidence during potentially stressful situations. It also provides a total score. The inventory scales, developed using factor analysis, were found to have a strong degree of internal reliability and concurrent validity. Preliminary testing suggested that positive change on these scales correlates with positive changes in the health status of chronic pain patients. Multiple regression analyses suggested that the interactions of these positive psychological attitudes with health status are not fully accounted for by the interactions of negative psychological attitudes with health status.

Predicting completion of a cognitive-behavioral pain management program by initial measures of a chronic pain patient' s readiness for change.

The treatment of chronic pain is costly and frustrating to the patient, health care provider and health care system. The highly subjective nature of pain, which is influenced by biological, psychological and sociological factors, contributes to this complex health care problem [1,2]. It is well known that the most effective chronic pain management consists of a multidisciplinary diagnostic and treatment approach [3]. A behavioral medicine model of chronic pain management can potentially fulfill that requirement as it acknowledges the biopsychosocial interaction in health and disease [4,5]. For a health maintenance organization (HMO), ‘inhouse’ chronic pain management system has its obvious benefits in reducing outside consultation services. However, a reduction in clinic utilization by these patients might also be predicted if patients were taught effective coping skills for symptom management, techniques that would allow for more self-control and more self-reliant participation in their health care (671. We examined clinic utilization and health care costs in 82 chronic pain patients exposed to a behavioral medicine intervention at the Matthew Thornton Health Plan, an HMO in Nashua, NH. Patients were referred by their internists, orthopedists and family practitioners because they had had chronic pain symptoms lasting longer than 6 months. Subjects were treated in 6 independent and sequential groups (groups I-VI). Only chronic pain patients who received all their health care through the HMO were included in the study. The intervention consisted of a 10 session, outpatient program invoiving weekly, 90 min group meetings. An