A recent study confirms previous findings that a multidisciplinary approach to the management of chronic musculoskeletal and fibromyalgia pain, which includes patients' motivated engagement in managing their own pain, is associated not only with better coping skills, but also with a positive impact on overall functioning.1
"The findings suggest that a person's readiness to self-manage his or her pain can play a key role in what that person does to manage pain and in his or her quality of life," lead investigator Mark Jensen, MD, Professor at the University of Washington School of Medicine's Department of Rehabilitation Medicine and attending psychologist at the University of Washington Multidisciplinary Pain Center, both in Seattle, told CIAOMed . "The study results also indicate that this readiness is flexible and can change when people are provided appropriate training and feedback concerning how they might better manage pain."
The results strongly suggest that interventions to increase motivation may lead to patients being more engaged in pain treatment strategies, and, therefore, to better outcomes, Dr. Jensen and colleagues reported in the journal Pain.
Focusing on the changes that occur through pretreatment, posttreatment, and 6-month follow-up, the current study found that readiness to self-manage pain changes over the course of a multidisciplinary pain treatment protocol; that changes in readiness to self-manage are associated with changes in patients' pain-coping strategies during treatment; and that readiness to self-manage pain is more strongly associated with the ability to cope with pain than with changes in actual pain and functioning.
Study subjects were participants in 2 outpatient, multidisciplinary pain treatment programs: a pain clinic sample (N = 99), and a fibromylagia sample (N = 320). Both programs emphasized improving pain management skills and physical and psychological functioning. In both study samples, the Pain Stages of Change Questionnaire (PSOCQ), the Chronic Pain Coping Inventory scales, and the Center for Epidemiological Studies – Depression Scale were used.
Physical disability was assessed by the Roland-Morris Disability Questionnaire for the pain clinic sample and by the interference scale of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) for the fibromyalgia sample. Pain severity measures were completed by self-rated measures of pain intensity (pain clinic sample) and by the Pain Severity scale of the WHYMPI (fibromyalgia sample).
Changes in readiness to self-manage pain assessed across both time intervals in the 2 patient samples were statistically significant (all P <0.001), and associated significantly with changes in the pain self-management coping composite. Change in readiness to self-manage pain was also associated significantly with change in pain severity. Consistent associations were found between improvement in depression and changes in 2 PSOCQ scales (ie, a decrease in the belief that management of pain is primarily the responsibility of medical professionals and an increase in attempts to improve and maintain self-management skills).
Increased understanding of motivational issues may have important clinical implications for improved outcomes. " Ideally, clinicians will start paying more attention not just to the advice they give patients but also, and perhaps more importantly, to the extent that the patient is ready to hear and act on that advice," Dr. Jensen told CIAOMed, adding that "part of what clinicians do is provide guidance and training; however, another – and perhaps overly neglected - aspect of clinical work is providing information and advice in a way that engages the patient. For me, this means listening carefully to a patient, to what he or she values and hopes for, and then working with that patient as a partner to develop a treatment plan that matches his or her own goals, values, and hopes," Dr. Jensen noted.
Findings are consistent with the hypothesis, derived from the Motivational Model of Pain Self-Management, that patients' motivation for self-managing pain is influenced by multidisciplinary treatment, including motivational interventions such as social reinforcement and decreased barriers for using self-management strategies.2
Dr. Jensen told CIAOMed that "it is now important to identify the specific clinician responses and behaviors that contribute the most to improved patient motivation, and then to develop training programs for clinicians to help encourage these responses and behaviors." He added that, "Ultimately, this should contribute to patients being able to take more control over their symptoms and health and, therefore, contribute to better long-term outcomes."
References:
- Jensen MP, Nielson WR, Turner, JA, Romano JM, Hill ML. Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping. Pain. 2004;111:84-95.
- Jensen MP, Nielson WR, Kerns RD. Toward the development of a motivational model of pain self-management. J Pain. 2003;4:477-492.