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Cognitive-behavioral therapy for persistent pain: does adherence after treatment affect outcome?
Charlotte Curran1, Amanda C de C Williams, Henry W W Potts
1Research Department of Clinical, Education and Health Psychology, University College London, Gower Street, London WC1E 6BT, United Kingdom.
European Journal of Pain (London, England)
|July 26, 2008
Summary
Long-term adherence to cognitive behavioral treatment (CBT) for persistent pain is emphasized, but this study found it has a minor direct impact on outcomes. Treatment gains are better predicted by combined end-of-treatment results and adherence factors.
Area of Science:
- Psychology
- Behavioral Science
- Pain Management
Background:
- Cognitive behavioral treatment (CBT) for persistent pain emphasizes long-term adherence for sustained benefits.
- Previous research has not quantified the causal impact of adherence on short-term treatment outcomes.
Purpose of the Study:
- To assess determinants of adherence to treatment recommendations in persistent pain patients.
- To examine the predictive value of cognitive and behavioral adherence on treatment outcomes.
Main Methods:
- Longitudinal data from 2345 persistent pain patients in a multicomponent treatment program.
- Structural equation modeling was used to analyze the data.
Main Results:
- Adherence acted as a mediator between post-treatment and follow-up outcomes, explaining only 3% of unique variance.
- Combined end-of-treatment outcomes and adherence factors explained 72% of the variance in one-month follow-up outcomes.
Conclusions:
- The study questions the significant emphasis typically placed on adherence for maintaining behavioral and cognitive changes in persistent pain management.
- Findings suggest that while adherence plays a role, end-of-treatment outcomes are stronger predictors of short-term results.
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