Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients: Long-Term Predictive Validity of Pretreatment and Posttreatment Change Scores and Stability of Posttreatment Scores.

Objectives:: 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 pre- and post-treatment PSOCQ change scores among chronic low back pain patients could predict six and twelve-month follow-up outcomes, and the stability of post-treatment PSOCQ scores during follow-up.

Methods:: Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (i.e., PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pre-treatment, 10 weeks post-treatment, 6-month follow-up, and 12-month follow-up assessments.

Results:: Multiple regression analyses showed that pre- and post-treatment 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. Post-treatment Pre-contemplation and Action/Maintenance scores were quite stable, even at 12-month follow up.

Conclusions:: 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.