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Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain?

Jensen, Mark P.a,b,*; Nielson, Warren R.c,d; Romano, Joan M.b,e; Hill, Marilyn L.d; Turner, Judith A.a,b,e

doi: 10.1016/S0304-3959(00)00257-8
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Patient readiness to adopt new beliefs and coping responses to pain may predict response to multidisciplinary or cognitive-behavioral pain treatments that emphasize changes in beliefs and coping behaviors. According to the transtheoretical model of change, individuals go through specific stages in the process of changing maladaptive behaviors. Based on this model, Kerns et al. (1997) (Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain 1997;72:227–234) developed a measure of readiness to adopt a self-management approach to pain problems (the Pain Stages of Change Questionnaire; PSOCQ) and provided preliminary data supporting the validity of the measure. The current study sought to further evaluate the PSOCQ by determining the generalizability of these preliminary findings and the ability of the PSOCQ to classify persons with chronic pain into specific stages of readiness to self-manage pain. One hundred ten patients with diverse chronic pain problems, and 119 patients with fibromyalgia completed the PSOCQ and two measures of pain-related beliefs and coping prior to entry into two separate multidisciplinary pain programs. The internal consistency and concurrent validity of the PSOCQ subscales were largely replicated, supporting the validity of the subscales as measures of readiness to self-manage pain. However, the PSOCQ demonstrated less utility as a tool for classifying individuals into one of four specific stages of readiness to adopt a self-management approach. This result may be due to the classification procedure used in the current study, the characteristics of the samples in the study, specific limitations of the measure, and/or limitations in the applicability of the transtheoretical model of change to patients with chronic pain.

aDepartment of Rehabilitation Medicine, Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA

bMultidisciplinary Pain Center, University of Washington Medical Center–Roosevelt, 4245 Roosevelt Way Northeast, Seattle, WA 98105-6920, USA

cDepartment of Medicine, Division of Rheumatology, University of Western Ontario, London, Ontario, N6A 5A5, Canada

dRheumatology Day Care Program, London Health Sciences Centre, London, Ontario, N6A 5A5, Canada

eDepartment of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA

*Corresponding author. Tel.: +1-206-543-3185; fax: +1-206-685-3244

E-mail: mjensen@u.washington.edu

Received 21 June 1999; received in revised form 10 January 2000; accepted 21 January 2000.

© 2000 Lippincott Williams & Wilkins, Inc.
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