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Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients

Long-term Predictive Validity of Pretreatment and Posttreatment Change Scores and Stability of Posttreatment Scores

Mun, Chung Jung PhD*; Otis, John D. PhD†,‡; Concato, John MD, MS, MPH§,∥; Reid, M. Carringotn MD, PhD; Burg, Matthew M. PhD§,#; Czlapinski, Rebecca MA**; Kerns, Robert D. PhD**,††,‡‡,§§

doi: 10.1097/AJP.0000000000000733
Original Articles

Objectives: In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients’ readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back pain patients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up.

Methods: Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments.

Results: Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up.

Conclusions: Changes in patients’ attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.

*Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD

Department of Psychiatry, Boston University School of Medicine

Research Service, VA Boston Healthcare System, Boston, MA

**Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System

Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven

Departments of §Internal Medicine



‡‡Neurology, Yale School of Medicine

§§Department of Psychology, Yale University, New Haven, CT

Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY

The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the United States government.

Supported by NIH NINDS (Bethesda, MD) T32 NS070201 (postdoctoral training for C.J.M.) and a Merit Review Grant from the Department of Veterans Affairs, Office of Research and Development, Clinical Science Research and Development Service and a Center of Innovation award from the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service, VA Connecticut Healthcare System, West Haven, CT. The authors declare no conflict of interest.

Reprints: Chung Jung Mun, PhD, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224 (e-mail:

Received January 12, 2019

Received in revised form April 25, 2019

Accepted May 22, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.