Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain?

M. K. Nicholas*, A. Asghari, M. Corbett, R. J. E. M. Smeets, B. M. Wood, S. Overton, C. Perry, L. E. Tonkin, L. Beeston

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitive-behavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.
Original languageEnglish
Pages (from-to)93-104
JournalEuropean Journal of Pain
Issue number1
Publication statusPublished - Jan 2012

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