Is adherence to pain self‐management strategies associated with improved pain, depression and disability in those with disabling chronic pain?

Abstract

There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitive-behavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.

Nursing Interventions in Patients with Chronic Pain and Depression: A Systematic Review

“…Australia (Dear et al, 2013;Nicholas et al, 2011;Chen & Francis, 2010) and the Netherlands (Samwel et al, 2009). In many of these studies, some of the participants were immigrants.…”

“…All participants had CP and in all the studies, some or all of them had depression. Instruments used by the studies to evaluate pain: Multidimensional Pain Inventory (Poleshuck et al, 2014;Nicholas et al, 2011;Darchuk et al, 2010); Escala numérica da dor (Fullen et al, 2013;Lattie et al, 2013;McCracken, Sato e Taylor, 2013;Tan et al, 2013;Tse, Vong e Tang, 2013); Beliefs About Pain Control Questionnaire (Fullen et al, 2013); Pain Self-efficacy Questionnaire (Nash et al, 2013;Tse, Vong e Tang, 2013;Dear et al, 2013); Escala Visual Analógica de Dor (Taloyan, Alinaghizadeh e Löfvander, 2013;Frich et al, 2012;Bremander, Holmström e Bergman, 2010;Chen e Francis, 2010;Samwel et al, 2009;Field et al, 2007); Pain Responses Self-Statements (Dear et al, 2013); Wisconsin Brief Pain Questionnaire (Dear et al, 2013); McGill Pain Questionnaire (Chen e Francis, 2010); Pain Catastrophizing Scale (Darchuk et al, 2010); Dutch version of the Pain Disability Index (Samwel et al, 2009); Pain Coping Inventory (Samwel et al, 2009); Brief Pain Questionnaire (Unützer et al, 2008).…”

“…ü Cognitive-behavioural therapy (CBT) (Fullen et al, 2013;Nash et al, 2013;McCracken, Sato & Taylor, 2013;Taloyan, Alinaghizadeh & Löfvander, 2013;Tan et al, 2013;Dear et al, 2013;Nicholas et al, 2011;Bremander, Holmström & Bergman, 2010;Darchuk et al, 2010;Samwel et al, …”

“…Of the 17 studies analysed, six were experimental studies -randomised control trials (Poleshuck et al, 2014;McCracken, Sato & Taylor, 2013;Tse, Vong & Tang, 2013;Dear et al, 2013;Frich et al, 2012;Chen & Francis, 2010) and eleven were pseudo-randomised trials (Fullen et al, 2013;Lattie et al, 2013;Nash et al, 2013;Taloyan, Alinaghizadeh & Löfvander, 2013;Tan et al, 2013;Nicholas et al, 2011;Bremander, Holmström & Bergman, 2010;Darchuk et al, 2010;Samwel et al, 2009;Unützer et al, 2008;Field et al, 2007). Based on our methodological quality instruments, we concluded that all the studies presented a high level of evidence.…”

Eficacia de un Tratamiento Cognitivo Comportamental (TCC) con apoyo de Tecnologías de la Información y la Comunicación (TICs) para el dolor lumbar crónico. Ensayo clínico aleatorizado

“…(2015) se estudió el efecto de la TCC en pacientes australianos con dolor crónico en un entorno de salud pública, a través de 5 sesiones online aplicadas a lo largo de 8 semanas, encontrándose grandes mejoras en variables como discapacidad, ansiedad, depresión y la media de dolor percibido tras el tratamiento, mejoras que fueron mantenidas en el seguimiento a los 3 meses. Además, se encontraron efectos de pequeños a moderados en otras variables de interés como la autoeficacia antes el dolor, el miedo al movimiento y la aceptación del dolor, que se han identificado como objetivos importantes en la TCC para el manejo del dolor (Nicholas et al, 2012;Nicholas et al, 2014). Por añadidura, los pacientes mostraron una elevada satisfacción con el tratamiento y una reducción del uso de medicación y de las demandas y el uso de los servicios de salud.…”