Readiness to Self-Manage Pain: New Perspectives on Pain Stages of Change.
详细信息
- 作者：Koenig ; Alexandra L.
- 学历：Ph.D.
- 年：2016
- 毕业院校：Seattle Pacific University.bClinical Psychology.
- Department：Physiologicalpsychology.
- ISBN：9781321808704
- CBH：3706783
- FileSize：581504
- Pages：78
文摘
Multidisciplinary pain management programs for chronic pain target increasing self-management skills and changing beliefs about pain in order to decrease pain severity, depressive symptoms, and pain-related anxiety. These programs are largely successful in treating individuals with chronic low back pain (CLBP). However, the mechanisms through which they are effective are not well understood. We examined two hypotheses using 188 CLBP patients who completed a multidisciplinary pain management program. We hypothesized that correlations would be significant between change in pain stages of change (PSOC), pain self-efficacy (PSE), pain, depressive symptoms, and pain-related anxiety. Secondly, we hypothesized that change in PSE would mediate the relationship between change in PSOC and change in pain, depressive symptoms, and pain-related anxiety. Using residualized change scores and structural equation modeling, we examined the significance of direct and indirect effects. Participants ranged in age from 20 to 81-years-old (M ＝ 43.61, SD ＝ 9.92) and were primarily Caucasian (86.20%). Sixty-eight percent of participants were male. Results largely supported our hypotheses. Correlations were significant for all change variables with the exception of the relationship between change in PSOC and change in pain, and the relationship between change in pain-related anxiety and change in pain. In addition, change in PSE mediated the relationships between change in PSE and change in pain severity (beta ＝ -.058； 95% CI ＝ -.108 to -.013, p ＝ .013), depressive symptoms (beta ＝ -.098； 95% CI ＝ -.185 to -.017, p ＝ .017), and pain-related anxiety (beta ＝ -.093； 95% CI ＝ -.165 to -.115, p ＝ .017). When the non significant covariance paths were trimmed the final model indicated good fit (chi2 ＝ 4.404, df ＝ 2, p ＝ .111； GFI ＝.991； CFI ＝.987； RMSEA ＝ 0.08). Findings suggest that change in PSOC is related to change in important outcome variables such as pain severity, depressive symptoms, and pain-related anxiety because patients are able to increase PSE over the course of treatment. This has implications for the design of multidisciplinary treatment programs and highlights the importance of targeting PSE. Additionally, these findings suggest that PSE is the primary mechanism for improving depression and pain-related anxiety in patients with CLBP.