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

Objective: There is a need to identify pretreatment patient indicators, whi ch are predictive of the successful enrollment and completion of chronic pa in treatment programs. Recent evidence suggests the Pain Stages of Change Q uestionnaire can predict enrollment and completion of a 10-session cognitiv e-behavioral pain management program. The purpose of this study is to deter mine whether the pretreatment Stages of Change Questionnaire can predict pa tients who would complete a cognitive-behavioral pain treatment program. Design: Prospective cohort study using logistic regression analyses. Settings: Patients referred for a 10-session cognitive-behavioral treatment program at a tertiary care multidisciplinary pain clinic or a community-ba sed specialty clinic. Subjects: Three hundred chronic pain patients (151 in the tertiary setting and 149 in the community-based setting) participated, with 147 of the patie nts (49%) completing and 153 (51%) patients not completing the 10-session p rogram. Intervention: Ten-visit cognitive-behavioral program for chronic pain patie nts. Outcome Measure: Completion of program. Results: The Stages of Change Questionnaire scores could predict completion status chi (2) (N = 300, 2 df) = 39.7, P <0.001, (goodness-of-fit test <ch i>(2) = 5.69, p = 0.68). Those patients completing the program were slightl y older and reported higher levels of pain, depression, and disability than did those patients who did not complete. Low "Precontemplation" score rema ined the best single predictor, as it identified correctly 61% of the cases patients who completed the program and predicted who would drop out in 65% of the cases. Conclusion: The Stages of Change Questionnaire is a potentially useful tool ; however, the current scoring method is insufficient to recommend its use as an inclusion or exclusion criterion for enrollment in a cognitive-behavi oral program.