Chronic pain: assessing and enhancing readiness to adopt a self-management approach

The aim of the research was to develop, implement and evaluate an intervention designed specifically to increase rates of engagement and adherence to self-management activities for chronic pain in a non pain-clinic population. The research comprised a series of four studies. Study 1, a questionnaire survey, explored the utility of the Transtheoretical model as a theoretical framework for assessing readiness to adopt a self-management approach to chronic pain and for developing appropriate treatment interventions. The findings indicated that the current application of the Transtheoretical model to chronic pain, the Pain Stages of Change model (Kerns et al. 1997) may not be useful in its current form. As such, the model required further adaptation in order to inform the development of interventions designed to increase engagement in treatment and adherence to self management activities.\ud \ud Study 2 comprised a series of qualitative interviews which expanded our conceptualisation of what constitutes a self-management approach and how best to assess and enhance readiness to adopt this type of approach. The qualitative data highlighted the discrepancy between the theoretical understandings of practitioners and the lived experience of those with chronic pain. Due to the lack of a clear definition of what constitutes a self management approach to pain, the apparent instability of the construct, the lack of explanatory value of stages of change and the range of activities inherent in a self-management approach, it was determined that traditional psychometric assessment may not be useful in treatment planning.\ud \ud The findings of Study 2a were used to formulate and develop an expanded model incorporating both stages of change and processes of change in relation to beliefs about specific self-management activities and current self management behaviour. The expanded model led to the development of the Readiness to Adopt a Self-Management Questionnaire (RASMAP-Q) in Study 111 2b. The questionnaire was designed to be administered in conjunction with standard assessment procedures using Motivational Interviewing techniques, with the aim of enhancing readiness to change prior to treatment.\ud \ud Study 3 comprised a randomised controlled trial to evaluate the efficacy of the RASMAP-Q intervention. The findings clearly demonstrate that the intervention increased rates of engagement in pain management workshops and adherence to treatment recommendations for up to six months for four of five self-management activities. The findings of the research as a whole indicates that the Transtheoretical model can be adapted to facilitate assessment and enhancement of readiness to adopt a self-management approach to pain in a community-based population