Patients' perceptions of their pain condition across a multidisciplinary pain management program - Do they change and if so does it matter?

Objectives: The primary aim of this study was to determine whether changes in cognitive processes are related to improved functional outcomes across a multidisciplinary pain management program. Methods: A longitudinal design was employed where patients completed 6 versions of the same questionnaire at the beginning, middle, and end of the 4-week treatment program and at 1, 3, and 6 months follow-up. Seventy-six patients consented to participate in this study. Outcome was assessed using the physical and mental component scores of the Short Form Health Questionnaire. Measures of cognitive processes included the Illness Perceptions Questionnaire Revised, the Pain Catas-trophizing Scale, and the Pain Vigilance and Awareness Questionnaire. Fifty-eight patients (76%) completed all 6 questionnaires. Results: We found reductions in catastrophizing and beliefs about the serious consequences of pain were most strongly associated with improved physical functioning, whereas reductions in pain vigilance, emotional representations of pain, and sense of coherence about pain were the best predictors of improved mental functioning. Overall, change in cognitive processes accounted for 26% of the variance in improved physical functioning and 23% of the variance in mental functioning. Discussion: These findings suggest that interventions that specifically target cognitive processes may enhance treatment effects for patients with chronic pain. Key Words: multidisciplinary pain program, illness perceptions, catastrophizing, pain vigilance, cognitive processes.