The validity of the stages of change model in the adoption of the self-management approach in chronic pain

In attempts to decrease chronic pain and the negative impact of chronic pain on broader functioning, patients can be stimulated to adopt self-management skills. However, not all patients are motivated to do so. Insight into the causes of motivation and the process of behavior change could increase the practitioners' effectiveness in stimulating patients to use self-management skills. The stages of change construct is a psychologic construct that maps the process of behavior change. Patients in the Precontemplation stage are not motivated to adopt self-management skills, patients in the Contemplation stage think about it, patients in the Preparation stage are planning to change and are already trying some (parts) of the skills, patients in the Action stage are actively learning to engage in self-management, whereas patients in the Maintenance stage keep on working to stabilize the new behavior pattern. Although the stages of change model is intuitively plausible and has the potential to increase effectiveness of the practitioners' counseling, its validity should be proven before it is applied clinically. The present article reviews the 8 available publications in which the stages of change construct is studied in patients with chronic pain. The results show that the theory of the stages of change needs more articulation, that the operationalization should be more directly derived from the theory, and that the results from more appropriate tests of the theory should be used to change the theory when necessary to develop it. Recommendations are made with regard to the theory, the operationalizations, and the tests to be conducted to develop the theory and assess its validity.