Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.

Abstract

Changes in maladaptive cognitions may constitute therapeutic processes of multidisciplinary pain programs. A cross-lagged panel design was used to determine whether (a) early-treatment cognitive change predicted late-treatment outcome index change, but not vice versa; and (b) these effects remained significant with depression change controlled. Ninety chronic pain patients, in a 4-week multidisciplinary program, completed measures of catastrophizing, pain helplessness, depression, pain, interference, and activity level at pre-, mid-, and posttreatment. With depression changes controlled, early-treatment catastrophizing and pain helplessness changes predicted late-treatment outcome index changes, but not vice versa; early-treatment depression changes predicted late-treatment activity changes, but not vice versa. Findings advance understanding of pain treatment process and suggest that negative cognition changes may indeed affect improvements in treatment outcome.

The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain

“…56,50,54 A large number of psychological variables have been identified as potential CBT process variables, including pain beliefs and perceived control over pain, 19,20,50 social support, 42,43 coping, 19,20 self-efficacy, 50 helplessness, [4][5][6] affective distress, and catastrophizing. 4,6,45,46,50,52 CBT-based treatments have typically taken a broad focus on processes for change and incorporated diverse packages of methods. So far evidence from studies of these treatments has not revealed which processes and methods are most effective or necessary in determining M A N U S C R I P T…”

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…96 In studies of CBT for chronic pain there are data showing that change in the content of thoughts can be associated with improvements during treatment. 9,35,79 At the same time a substantial number of studies suggest that it is unnecessary to employ methods that target the content of thoughts for change in treatment for chronic pain. Thoughts may change substantially or not very much during treatment and in either case good outcomes can be achieved.…”

Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

“…Specifically, pain catastrophizing, self-efficacy, and centrality were examined. Pain catastrophizing has been previously linked with higher pain intensity and greater disability, and reductions of catastrophic thinking are associated with positive pain treatment outcomes [51][52]. The study team considers it clinically meaningful, then, to find significantly greater pain catastrophizing among those who also experience PTSD.…”