Treatment Expectancy Affects the Outcome of Cognitive-Behavioral Interventions in Chronic Pain

Abstract

Patients' initial beliefs about the success of a given pain treatment are shown to have an important influence on the final treatment outcome. The aims of the paper are to assess determinants of patients' treatment expectancy and to examine the extent to which treatment expectancy predicts the short-term and long-term outcome of cognitive-behavioral treatment of chronic pain. This study employs the data of 2 pooled randomized clinical trials evaluating the effectiveness of cognitive-behavioral interventions for 171 patients with fibromyalgia and chronic low back pain. Pretreatment and posttreatment expectancy were measured by a short questionnaire, which was based on the procedure by Borkovec and Nau. Four composite outcome variables (pain coping and control, motoric behavior, negative affect, and quality of life) were measured before and after the intervention and at 12 months follow-up. Furthermore, several patient characteristics were taken into account. Patients with higher treatment expectancies significantly received less disability compensation and were less fearful. A regression model of 3 factors (better pain coping and control, active and positive interpretation of pain, and less disability compensation) significantly explained 10% of the variance in pretreatment expectancy. Pretreatment expectancy significantly predicted each of the 4 outcome measures immediately after treatment and at 12 months follow-up. This study corroborates the importance of treatment expectation before entering a cognitive-behavioral intervention in patients with chronic musculoskeletal pain.

Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

“…with respect to the mean age of 45.6 years, this finding is in agreement with other reports in the literature, as is the finding that the majority of patients were not currently carrying out their professional activities, a fact that corroborates the limiting nature of the pain 11 . The social damage resulting from the pain is an indicator of the impact of the symptom on the life of the affected individual, suggesting a change in the patient's quality of life with respect to being able to carry out physical, intellectual, psychic and occupational activities 12 .…”

Patients’ perceptions of the effectiveness of guided imagery and progressive muscle relaxation interventions used for cancer pain

“…Variables including age, race, education, pain duration, number of pain sites, concurrent symptoms, depression, somatization, perceived stress, treatment expectancy, readiness to change, and cognitive aptitude for specific strategies have been suggested as potential moderators of treatment effects [4,14,[19][20][21]. Patients' perceptions of the factors that explain why specific cognitive-behavioral strategies work or fail to work have not been reported in previous literature.…”

Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

“…In one study, expectations for a cognitive–behavioral intervention were found to be associated with outcomes in patients with fibromyalgia or chronic low back pain. 22 In trials looking at both physical and behavioral therapies for low back pain, prior expectations for improvement have been found to be associated with effectiveness of the treatment 19 and disability and satisfaction. 23 Expectations have also been shown to be associated with outcomes in pain trials of acupuncture, 18,24,25 massage, 24 and paracetamol.…”