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Predicting Completion of a Cognitive-Behavioral Pain Management Program by Initial Measures of a Chronic Pain Patient's Readiness for Change

Biller, Nikola M.D.*; Arnstein, Paul Ph.D., A.R.N.P.†‡; Caudill, Margaret A. M.D., Ph.D.; Federman, Carol Wells M.S., M.Ed., R.N., C.S.; Guberman, Carolyn B.A.

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Objective: There is a need to identify pretreatment patient indicators, which are predictive of the successful enrollment and completion of chronic pain treatment programs. Recent evidence suggests the Pain Stages of Change Questionnaire can predict enrollment and completion of a 10-session cognitive-behavioral pain management program. The purpose of this study is to determine whether the pretreatment Stages of Change Questionnaire can predict patients who would complete a cognitive-behavioral pain treatment program.

Design: Prospective cohort study using logistic regression analyses.

Settings: Patients referred for a 10-session cognitive-behavioral treatment program at a tertiary care multidisciplinary pain clinic or a community-based specialty clinic.

Subjects: Three hundred chronic pain patients (151 in the tertiary setting and 149 in the community-based setting) participated, with 147 of the patients (49%) completing and 153 (51%) patients not completing the 10-session program.

Intervention: Ten-visit cognitive-behavioral program for chronic pain patients.

Outcome Measure: Completion of program.

Results: The Stages of Change Questionnaire scores could predict completion status χ2 (N = 300, 2 df) = 39.7, p <0.001, (goodness-of-fit test χ2 = 5.69, p = 0.68). Those patients completing the program were slightly older and reported higher levels of pain, depression, and disability than did those patients who did not complete. Low "Precontemplation" score remained the best single predictor, as it identified correctly 61% of the cases patients who completed the program and predicted who would drop out in 65% of the cases.

Conclusion: The Stages of Change Questionnaire is a potentially useful tool; however, the current scoring method is insufficient to recommend its use as an inclusion or exclusion criterion for enrollment in a cognitive-behavioral program.

*Center for Psychosocial Medicine, University of Goettingen, Germany; †Boston College, Boston, Massachusetts; ‡Dartmouth Hitchcock Clinic, Manchester, New Hampshire

Received January 13, 1999; accepted as revised August 3, 2000.

Address correspondence and reprint requests to Dr. Margaret A. Caudill, Dartmouth Hitchcock Clinic, 100 Hitchcock Way, Manchester, NH 03104.

© 2000 Lippincott Williams & Wilkins, Inc.