Roberta Rosenberg

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.

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.

Veterans' reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system

The improved management of pain among veterans seeking care in Veterans Health Administration (VHA) facilities has been established as a priority. This study documents the high prevalence of reports of pain among a convenience sample of 685 veterans seeking care in a VHA primary care setting. Also reported are associations of pain complaints with self-rated health, an index of emotional distress, health-risk behaviors such as tobacco and alcohol use, health-related concerns about diet and weight, and perceptions of the availability of social support. The relationship between the presence of pain and use of outpatient and inpatient medical and mental health services is also examined. Nearly 50% of the sample reported that they experience pain regularly and that they were concerned about this problem at the time of the index visit to their primary care provider. Persons acknowledging the presence of pain, relative to those not reporting pain, were younger, reported worsening health over the past year, had greater emotional distress, used tobacco, had diet and/or weight concerns, and were found to use more outpatient medical, but not inpatient medical or mental health services. Results support the goals of the VHA National Pain Management Strategy designed to reduce unnecessary pain and suffering among veterans receiving care in VHA facilities.

Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model.

Abstract Psychological treatments emphasizing a self‐management approach have become commonly accepted alternatives to medical interventions for chronic pain. Unfortunately, these approaches often fail to engage a significant portion of targeted individuals and are associated with high drop‐out and relapse rates. Informed by the transtheoretical model of behavior change and the cognitive behavioral perspective on chronic pain, the Pain Stages of Change Questionnaire (PSOCQ) was developed to assess readiness to adopt a self‐management approach to chronic pain. Initial studies supported the reliability and validity of four distinct scales, Precontemplation, Contemplation, Action and Maintenance. The current study was designed to assess the ability of the PSOCQ to predict self‐management participation and outcome. The PSOCQ and several relevant outcome measures were assessed before and after self‐management treatment by 109 chronic pain patients. Profile analysis revealed that treatment completers and non‐completers differed significantly across the four PSOCQ scales. Post‐hoc comparisons indicated that pretreatment PSOCQ Precontemplation and Contemplation scores discriminated these two groups. Separate analyses revealed that Action and Maintenance scores increased over the course of treatment, and that changes in the PSOCQ scales were associated with improved outcomes. These findings suggest that increased commitment to a self‐management approach to chronic pain may serve as a mediator or moderator of successful treatment. This study supports the predictive validity and utility of the PSOCQ, as well as the relevance of the stages of change model to self‐management of chronic pain.

Understanding the adoption of arthritis self-management: stages of change profiles among arthritis patients

&NA; Clinical observations and recent studies suggest that arthritis patients vary considerably in their involvement in self‐management efforts. In the literature on health promotion, there is growing recognition that patients may be at different stages of change with respect to the adoption of self‐management strategies. The major goal of the present study was to examine whether cluster analysis could be used to identify homogeneous subgroups of patients having persistent arthritis pain based on their responses to a stages of change questionnaire. Participants in this study (103 patients having rheumatoid arthritis and 74 patients having osteoarthritis) completed a stages‐of‐change measure specific to adoption of a self‐management approach to their arthritis. A cluster analysis identified five distinct subgroups of arthritis patients: (1) precontemplation – 44% of the sample; (2) contemplation – 11% of the sample; (3) preparation – 22% of the sample; (4) unprepared action – 6% of the sample; and (5) prepared maintenance – 17% of the sample. These subgroups are generally consistent with what might be expected based on the transtheoretical model of stages of change by Prochaska and DiClemente (Prochaska JO, DiClemente CC. Towards a comprehensive, transtheoretical model of change: states of change and addictive behaviors. In: Miller WR, Heather N, editors. Applied clinical psychology, 2nd ed. Treating addictive behaviors, New York: Plenum Press, 1998. pp. 3–24.), and may have important clinical implications. For example, it is possible that the arthritis subgroups identified may predict arthritis patients’ participation in and responsiveness to pain‐coping skills training, exercise interventions, or other formal self‐management training programs. Also, one may be able enhance the outcomes of self‐management interventions for arthritis by tailoring treatment to the patients particular stage.

The pain behavior check list (PBCL): factor structure and psychometric properties

The construct of “pain behaviors” as observable and measurable manifestations of pain occupies a central role in Fordyces operant model of pain. The present study was designed to evaluate the multidimensional nature of the construct and to explore the psychometric properties of a newly developed self-report instrument called the Pain Behavior Check List (PBCL). Subjects were 126 chronic pain patients who completed an initial version of the PBCL and other standardized questionnaires as part of their evaluation by the West Haven VAMC. Factor analysis identified four factors labeled Distorted Ambulation, Affective Distress, Facial/Audible Expressions, and Seeking Help. Substantial reliability and stability estimates for the total PBCL and the subscales support the potential clinical and theoretical utility of the instrument.

Self-appraised problem solving and pain-relevant social support as predictors of the experience of chronic pain.

The purpose of this study was to examine the contributions of self-appraised problem-solving competence and pain-relevant social support to the prediction of pain, depression, and disability. The 234 chronic pain patients referred for participation in a comprehensive pain management program were administered self-report measures of pain, depression, disability, pain-relevant social support, and problem solving. Hierarchical multiple-regression analyses revealed that lower self-appraised problem-solving competence was related to increased pain, depression, and disability. Pain-relevant social support was directly related to pain and disability but indirectly related to depression. High levels of pain-relevant social support were found to buffer the relation between poorer self-appraised problem-solving competence and depressive symptoms. The results support the assessment of problem-solving skills in chronic pain patients and the investigation and utility of interventions aimed at increasing adaptive pain-relevant social support.

Pain-relevant support as a buffer from depression among chronic pain patients low in instrumental activity

ObjectiveThis study examined the hypothesis that among chronic pain patients lacking participation in activities, perceived pain-relevant spousal support would act to compensate for a low level of social reinforcement and provide a buffer against depression. DesignHierarchical regression analyses were conducted to examine the relative and cumulative effects of support and activity, and their interactions, in the prediction of depression severity. SettingThe study setting was a training and research oriented Veterans Administration Medical Center. PatientsParticipants were 105 married, male chronic pain patients evaluated for a comprehensive pain management program. Main Outcome MeasureDepression severity was measured by the Beck Depression Inventory. ResultsThree categories of activity, and perceived interference of pain accounted for significant proportions of the variance in depression severity scores beyond that accounted for by age and pain severity. Support was not predictive of depression. Interactions between interference and support, and between two of the specific activities and support added significantly to the prediction of depression. ConclusionsResults are consistent with a buffering model of social support in which perceived spousal support among chronic pain patients appears to moderate the potentially deleterious effects of a low level of activity.

Self-efficacy as a psychological moderator of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and a variety of somatic symptoms. Few studies have examined psychological aspects of CFS. In the present study, self-efficacy is shown to be a significant predictor of CFS symptoms beyond the variance accounted for by demographic variables and distress. Further psychological CFS research is encouraged by (1)identifying dimensions that are salient in the experience and study of CFS, (2) providing preliminary psychometric data for measures of those dimensions, and (3)identifying psychological variables that serve as moderators of the experience of CFS.

Social sharing of Gulf War experiences: Association with trauma-related psychological symptoms

It commonly is believed that talking with family and friends (social sharing) about stressful or traumatic experiences can be therapeutic with regard to stress-related psychological symptoms. Two years after serving in the Gulf War, 58 National Guard Reservists completed the Mississippi Posttraumatic Stress Disorder Scale (PTSD), the Brief Symptom Inventory, and a measure of social sharing that asked how much they had talked to family and friends about their experiences in the Gulf during the 2-year period since returning from the war. Subjects had a broad range of Mississippi PTSD scores. Six subjects met Mississippi criteria for PTSD. Degree of talking to family and friends about Gulf War experiences did not account for a significant portion of the variance in the prediction of PTSD symptoms but did significantly contribute to prediction of scores for interpersonal sensitivity, depression, and psychoticism. Thus, degree of talking with family and friends was not found to be related to PTSD symptoms, although it may have influenced some symptoms of general psychopathology, such as depression, that are not specific to PTSD.