A Prospective Examination of Acceptance at a CBT-based Interdisciplinary Chronic Pain Management Program
DOI:
https://doi.org/10.17140/PCSOJ-4-139Keywords:
Pain, Acceptance, CBT, Prospective, Patient adjustmentAbstract
Aims/Objectives: Acceptance of chronic pain is related to active patient engagement in valued aspects of life. This study sought
to prospectively evaluate acceptance and patient functioning in a Cognitive Behavioural Therapy (CBT) - based chronic pain
management program.
Methods: Participants in this study were 184 consecutive adult patients with heterogeneous pain admitted to a interdisciplinary
four-week Chronic Pain Management Program (CPMP) who completed self-report questionnaires at admission and discharge.
Measures examined pain perception, psychological/emotional and social aspects of patient experience with chronic pain. Acceptance
was evaluated by the Chronic Pain Acceptance Questionnaire (CPAQ).1
Results: Patients showed all-round improvement after program completion. Consistent with other studies, higher acceptance
scores at admission were associated with more overall positive change at discharge. In addition, greater increase in acceptance
scores at discharge was also associated with greater improvement in other variables. However, no significant change was shown
in the Pain Willingness subscale of the CPAQ.
Discussion: This study provides a new understanding of the relationship of acceptance of chronic pain with patient functioning
in a CBT-oriented pain management program. Results suggest that engaging in activity regardless of pain is an important
program goal. This is directly measured by the Activity Engagement component of the CPAQ, which increases following participation
in a CBT-based CPMP. Study findings also differ from some previous research and suggest that Pain Willingness may
be a poor predictor of patient functioning.
Limitations: Results were obtained from patients at an interdisciplinary program and may not be generalized to the entire chronic
pain population. Also, these results only demonstrate associations between acceptance and other variables, not causality. In addition,
patients in this study served as their own controls (admission-discharge) thus the study lacks a true control group.
Conclusion: This study extends previous research by contributing needed prospective data on the relationship between acceptance
and patient functioning.
References
McCracken LM, Vowles K. Acceptance of Chronic Pain. Curr Pain and Headache Rep. 2006; 10(2): 90-94.
Wetherell JL, Afari N, Rutledge T, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behav-ioral therapy for chronic pain. Pain. 2011; 152(9): 2098-2107. doi: 10.1016/j.pain.2011.05.016
McCracken LM, Vowles K, Eccleston C. Acceptance of chron-ic pain: component analysis and a revised assessment method. Pain. 2004; 107(1-2): 159-166. doi: https://doi.org/10.1016/j. pain.2003.10.012
Geisser D. A comparison of acceptance-focused and control-fo-cused psychological treatments in a chronic pain treatment center. University Microfilms International, University of Nevada, Reno, USA: 1-10, 1992.
McCracken LM, Eccleston C. Coping or acceptance: What to do about chronic pain? Pain. 2003; 105(1-2): 197-204. doi: https://doi. org/10.1016/S0304-3959(03)00202-1
Viane I, Crombez G, Eccleston C, et al. Acceptance of pain is an independent predictor of mental wellbeing in patients with chronic pain: Empirical evidence and reappraisal. Pain. 2003; 106(1-2): 65- 72. doi: 10.1016/S0304-3959(03)00291-4
McCracken LM. Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain. 2005; 113(1- 2): 155-159. doi: 10.1016/j.pain.2004.10.004
Asmundson G, Hadjistavropoulos H. Acceptance and Commit-ment therapy in the rehabilitation of a girl with chronic idiopathic pain: are we breaking new ground? Cogn Behav Pract. 2006; 13(3): 178-181. doi: 10.1016/j.cbpra.2006.05.001
McCracken LM, Eccleston C. A prospective study of accept-ance of pain and patient functioning with chronic pain. Pain. 2005; 118164-118169. doi: https://doi.org/10.1016/j.jpain.2005.01.212
Schütze R, Rees C, Smith A, Slater H, Campbell JM, O’Sullivan P. How Can We Best Reduce Pain Catastrophizing in Adults with Chronic Non-Cancer Pain? a Systematic Review and Meta-Analy-sis. J Pain. 2017; 23(1): 21-29. doi: 10.1016/j.jpain.2017.09.010
Townsend C, Bruce B, Hooten W, Rome J. The role of mental health professionals in multidisciplinary pain rehabilitation pro-grams. J Clin Psychol. 2006; 11: 1433-1443. doi: 10.1002/jclp.20322
Maruta T, Swanson D, McHardy M. Three year follow up of patients with chronic pain who were treated in a multidisci-plinary pain management center. Pain. 1990; 41(1): 47-53. doi: 10.1016/0304-3959(90)91108-U
Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Ac-ceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain. 2011; 152(3): 533-542, doi: 10.1016/j.pain.2010.11.002
Cederberg JT, Cernvall M, Dahl J, von Essen L, Ljungman G: Acceptance as a mediator for change in acceptance and commit-ment therapy for persons with chronic pain?. Int J Behav Med. 2016; 23(1): 21-29, doi: 10.1007/s12529-015-9494-y
Jensen M, Romano J, Turner J, Good A, Wald L. Patient beliefs predict patient functioning: Further support for a cognitive-be-havioral model of chronic pain. Pain. 1999; 81(1-2): 94-104. doi: 10.1016/S0304-3959(99)00005-6
Spitzer R, Williams J, Kroenke K, et al. Utility of a new proce-dure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994; 272(22): 1749-1756. doi: 10.1001/ jama.1994.03520220043029
Radloff L. The CES-D Scale. A self-report depres-sion scale for research in the general population. Applied Psychological Measurement. 1977; 1(3): 385-401. https://doi. org/10.1177/014662167700100306
Thyer B. Development and validation of the Clinical Anxiety Scale. A rapid assessment instrument for empirical practice. Edu-cational and Psychological Measurement. 1989; 49(1): 153-163. https:// doi.org/10.1177/0013164489491016
Bandura A.The anatomy of the stages of change. Am J Health Promot. 1997; 12: 8-10. doi: 10.4278/0890-1171-12.1.8 Original Research | Volume 4 | Number 1| Hapidou EG, et al
Kerns R, Wagner J, Rosenberg R, Haythornthwaite J, Cau-dill-Slosberg M. Identification of subgroups of persons with chron-ic pain based on profiles on the pain stages of change question-naire. Pain. 2005; 116(3): 302-310. doi: 10.1016/j.pain.2005.04.022
Jensen M, Turner J, Romano J, Strom S. The Chronic Pain Cop-ing Inventory. Development and preliminary validation. Pain. 1995; 60(2): 203-216. doi: 10.1016/0304-3959(94)00118-X
Sullivan M, Bishop S, Pivik J. The pain catastrophizing scale: Development and validation. Psychological Assessment. 1995; 7(4): 524-532. doi: http://dx.doi.org/10.1037/1040-3590.7.4.524
Hapidou, EG. Program evaluation of pain management pro-grams. Paper presented at the 9th Inter-Urban Pain Conference, Kitchener, Ontario, Canada, 1994.
Jensen M, Karoly P, Braver S. The measurement of clinical pain intensity: A comparison of six methods. Pain. 1986; 27(1): 117-126, https://doi.org/10.1016/0304-3959(86)90228-9
Geisser M, Roth R, Robinson M. Assessing the depression among persons with chronic pain using the Center for Epidemio-logical Studies-Depression Scale and the Beck Depression Inven-tory: A comparative analysis. Clin J Pain. 1997; 13(2): 163-170. doi: 10.1097/00002508-199706000-00011
Magni G, Moreschi C, Rigatti-Luchini S, Merskey H. Pro-spective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain. 1994; 56(3): 289-297, doi: 10.1016/0304-3959(94)90167-8
Turk D, Okifuji A, Scharff L. Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts. Pain. 1995; 61(1): 93-101. doi: 10.1016/0304-3959(94)00167-D
Hudson W. The Clinical Measurement Package: A Field Manual. Homewood, IL, Dorsey Press, 1982.
McCracken LM, Eccleston C. A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. Eur J Pain. 2006; 10(1): 23-29. doi: 10.1016/j. ejpain.2005.01.004
Haidar R. Relationships between chronic pain treatment out-comes and pain-related psychological variables. Unpublished un-dergraduate thesis, McMaster University, Ontorio, Canada, 2004.
Hapidou EG, Abbasi H. Readiness to adopt a self-management approach to chronic pain and pain management outcomes. PAIN PRACTICE, Book of Abstracts, 3rd World Congress, 2004; 72(1): 21-25. World Institute of Pain, Barcelona, Spain, doi: 10.1016/ S0304-3959(97)00038-9
Nassar D. Stage of change and development of a self-manage-ment approach in chronic pain. Unpublished undergraduate thesis, McMaster University, Ontorio, Canada, 2006.
Williams RM, Hapidou EG, Lin CY, Abbasi H. Examining the use of the pain stages of change questionnaire in chronic pain. Physiotherapy Canada. 2007; 59(2): 132-141. doi: https://doi. org/10.3138/ptc.59.2.132
McCracken LM. Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998; 74(1): 21-27. doi: 10.1016/S0304-3959(97)00146-2
Lipchik G, Milles K, Covington E. The effects of multidisci-plinary pain management treatment on Locus of Control and pain beliefs in chronic non-terminal pain. Clin J Pain. 1993; 9(1): 49-57.
Nicholas M, Asghari A. Investigating acceptance in adjustment to chronic pain: Is acceptance broader than we thought? Pain. 2006; 124(3): 269-279. doi: 10.1016/j.pain.2006.04.032
Vowles K, McCracken LM, Eccleston C. Processes of change in treatment for chronic pain: The contributions of pain, accept-ance and catastrophizing. Eur J Pain. 2006; 11(7). doi: 10.1016/j. ejpain.2006.12.007
Carr J, Moffett J, Sharp D, Haines D. Is the pain stages of change questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? Further evidence of validity, on a sample of UK pain clinic patients. BMC Musculoskelet Disord. 2006; 7: 101-108. doi: https://doi.org/10.1186/1471-2474-7-101
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