Predictors of response to pain management treatment. The role of family environment and changes in cognitive processes.
OBJECTIVE: The purpose of the present study was to examine factors that influence individual differences in treatment response after multidisciplinary pain management. DESIGN: Pre-post assessment design. PATIENTS: 119 chronic pain inpatients. MAIN MEASURES: Outcome measures included pain report from the McGill Pain Questionnaire, emotional distress from the Symptom Checklist-90 Revised, and activity discomfort from the Activity Discomfort Scale. Process measures included the Family Environment Scale, the Coping Strategies Questionnaire, and the Inventory of Negative Thoughts in Response to Pain. RESULTS: Results indicated that pretreatment family environment, cognitive coping strategies, and negative thinking accounted for small yet significant proportions of the variance in outcome. The proportion of variance accounted for by the changes in cognitive coping and negative thinking was somewhat higher. An increase in pain control and rational thinking was related to decreases in depression and anxiety, pain report, and activity discomfort. Decreases in negative social cognitions were related to decreased depression at posttreatment. CONCLUSIONS: Changes in coping strategies and negative thinking may be important mechanisms related to improvement, or lack of improvement, in a range of outcome measures. Patients from families who are controlling and disorganized, and patients high on negative thinking at pretreatment may represent high-risk groups in need of further individually tailored interventions.
Tota-Faucette, ME; Gil, KM; Williams, DA; Keefe, FJ; Goli, V
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