Open Access(201) The Effect of an Integrated Cognitive‐Behavioral Pain Management Program on Pain Intensity, Self‐efficacy Beliefs and Depression in Chronic Pain Patients on Completion and One Year Later
Author(s) -
Arnstein Paul,
WellsFederman Carol,
Caudill Margaret
Publication year - 2001
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2001.pme01039-2.x
Subject(s) - medicine , depression (economics) , pain catastrophizing , chronic pain , physical therapy , cognition , cognitive behavioral therapy , clinical psychology , psychiatry , economics , macroeconomics
Cognitive‐behavioral treatment programs have demonstrated the ability to reduce pain, emotional distress and disability for individuals with chronic pain. Investigators suspect a change in self‐efficacy beliefs may be the mechanism by which these positive outcomes occur. This investigation examined pre‐ and post‐program data from participants of an integrated cognitive‐behavioral program, to identify patterns of change in the areas of pain intensity (visual analogue scale), self‐efficacy beliefs (Chronic Pain Self‐Efficacy Scale), pain‐related disability (Pain Disability Index) and depression (CES‐D) in 170 chronic pain patients. At the end of the 10‐session treatment program, the greatest area of change was an increase in self‐efficacy levels by 38% from baseline. This increase was significantly (p < 0/00.1) associated with a 24% reduction in pain intensity, while disability and depression scores declined by 17% and 28% respectively. Patients responding to a follow‐up survey one year after completion (n = 41) reported continued improvements. Pain, disability and depression scores declined to 27%, 25%, and 32% respectively. Self‐efficacy scores remained the same (38% higher than baseline) as the immediate post‐program scores remained the same (38% higher than baseline) as the immediate post‐program measures. All were significant at the p < 0.001 level. Changes remained significant after controlling for pain intensity, and use of antidepressants &/or opioids. Self‐efficacy levels at the conclusion of the program were significantly (p < 0.01) related to pain intensity (r = −.58), disability (r = −.65) and depression (r = −.65). In the one‐year data set, even stronger associations were noted. Conclusion: Support continues to mount that desirable outcomes occur as a result of participation in an integrated cognitive‐behavioral pain program. Reductions in pain, disability and depression occur in association with an enhancement in self‐efficacy beliefs. The beneficial effects of the program continue after its conclusion, as pain, disability and depression scores continue to fall, and self‐efficacy continues to rise one year after program completion.