(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

Abstract

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.