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Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients

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In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients’ readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back pain patients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up.


Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments.


Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up.


Changes in patients’ attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.
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Keywords: chronic pain; cognitive behavioral therapy; self-management; stages of change

Document Type: Research Article

Affiliations: 1: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 2: Department of Psychiatry, Boston University School of Medicine, Research Service, VA Boston Healthcare System, Boston, MA 3: Departments of Internal Medicine, Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven 4: Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY 5: Departments of Internal Medicine, Anesthesiology 6: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System 7: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, Psychiatry, Neurology, Yale School of Medicine, Department of Psychology, Yale University, New Haven, CT

Publication date: September 1, 2019

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