Predictors of Adherence to Pain Self-Management Strategies in Chronic Pain: Motivation to Change Pain Related Behaviour

Adherence to self-management strategies during multidisciplinary pain management interventions has been shown to be a significant predictor of pain outcomes. Despite these findings, the reasons patients adhere to self-management strategies is poorly understood. Therefore, it is difficult to know in what way to best improve adherence in order to maximise treatment-related gains. Readiness to adopt new pain behaviours has shown promise as a construct that can be used to predict adherence to prescribed pain behaviours.«br /» «br /» This research project comprised of an empirical study and a meta-analysis and systematic review. The meta-analysis and systematic review aimed to determine whether motivational interviewing approaches are effective in improving adherence, pain and physical function for patients with chronic pain. The results from seven studies indicate that MI leads to short-term increases in adherence to chronic pain treatments, although publication bias cannot be ruled out as an explanation for the findings. Further, it is as yet unclear whether these effects result in improvements in patient function.«br /» «br /» After establishing preliminary evidence that motivational interviewing approaches increase adherence to chronic pain treatment, an empirical study was established to explore the potential mechanisms associated with such increases. The study was primarily designed to determine whether readiness to adopt pain self-management strategies predicted these behaviours in a three-week multidisciplinary pain management program. The study also explored the relationship between individual’s beliefs about the perceived benefit in using self-management strategies and adherence to these strategies. The treating clinical psychologist rated participants adherence to each self-management strategy taught in the pain management program at the end of each week using a scale of 0 to 2, where 0 = ’not using the strategy at all’, 1 = ’using it inconsistently’, and 2 = ’using it consistently’.«br /» «br /» One hundred and nineteen participants consented to participate in the study. The major finding of this study was that individual’s perceived benefit in adopting self-management strategies early in treatment predicted small improvements in pain management coping behaviours in subsequent weeks of the program, particularly perceived benefit in the first week of the program. Interestingly, no strong bi-directional relationships were observed. That is, adherence did not predict individual’s perceived benefit in using self-management strategies in subsequent weeks. Contrary to expectations, readiness to adopt pain management strategies at baseline was not associated with adherence to self-management strategies during any week of the three-week program. Furthermore, this study failed to replicate the robust findings of past research that showed adherence to be an independent predictor of pain outcomes.«br /» «br /» The findings of this research project raises questions about the theoretical and clinical application of the transtheroetical model and the motivational model of pain self-management in chronic pain. Based on the findings, other health psychology models such as the health belief model may have more value for predicting adherence to chronic pain treatment. This research project also highlights the importance of individual’s expectancies and the process of change in chronic pain treatment. In particular, there is a need for more process-oriented research that assesses the temporal aspects of change so that an understanding of the mechanisms of change can be identified. This would in turn inform how current approaches to chronic pain treatment can be improved. Finally, the findings of the empirical study stress the need for valid and reliable measures of adherence that not only gauge participant adherence but therapist fidelity to therapeutic processes

Adverse consequences of student drinking : the role of sex, social anxiety, drinking motives

This study examined whether biological sex, social anxiety, and drinking motives relate differently to distinct types of alcohol-related consequences using Poisson regression. One hundred eighteen college students completed self-report measures assessing drinking motives and social anxiety and an interview assessing alcohol consumption and consequences. Highly socially anxious women were particularly apt to experience adverse role functioning consequences, while men were particularly apt to experience physical consequences. Although highly socially anxious women reported more personal consequences than did women with low to moderate social anxiety, men with low to moderate social anxiety reported experiencing more social and personal consequences than did women with low to moderate social anxiety. When taking into consideration the above associations, coping motives were statistically associated with social consequences and marginally related to personal consequences, while enhancement motives were significantly associated with physical consequences. Targeting these factors may lead to effective interventions for individuals with co-occurring social anxiety and drinking problems.8 page(s