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

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 r ates. Informed by the transtheoretical model of behavior change and the cog nitive behavioral perspective on chronic pain, the Pain Stages of Change Qu estionnaire (PSOCQ) was developed to assess readiness to adopt a self-manag ement approach to chronic pain. Initial studies supported the reliability a nd validity of four distinct scales, Precontemplation, Contemplation, Actio n and Maintenance. The current study was designed to assess the ability of the PSOCQ to predict self-management participation and outcome. The PSOCQ a nd several relevant outcome measures were assessed before and after self-ma nagement 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 PSO CQ Precontemplation and Contemplation scores discriminated these two groups . Separate analyses revealed that Action and Maintenance scores increased o ver the course of treatment, and that changes in the PSOCQ scales were asso ciated with improved outcomes. These findings suggest that increased commit ment to a self-management approach to chronic pain may serve as a mediator or moderator of successful treatment. This study supports the predictive va lidity and utility of the PSOCQ, as well as the relevance of the stages of change model to self-management of chronic pain. (C) 2000 International Ass ociation for the Study of Pain. Published by Elsevier Science B.V.