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Does validation and alliance during the multimodal investigation affect patients' acceptance of chronic pain?: An experimental single case study
Pychosomatic Medicine Clinic, Region of Västmanland, Västerås, Sweden.
School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-9429-9012
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 1, p. 73-82Article in journal (Refereed) Published
Abstract [en]

Background and aims: Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients' experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process.

Methods: Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5-10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6-8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI.

Results: Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI.

Conclusions: The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019. Vol. 19, no 1, p. 73-82
Keywords [en]
assessment, chronic pain, multidisciplinary pain clinic, pain measurement, rehabilitation
National Category
Psychology (excluding Applied Psychology) Neurology
Identifiers
URN: urn:nbn:se:oru:diva-70001DOI: 10.1515/sjpain-2018-0051ISI: 000455520700009PubMedID: 30375349Scopus ID: 2-s2.0-85056261752OAI: oai:DiVA.org:oru-70001DiVA, id: diva2:1261258
Note

Funding Agency:

Region of Västmanland

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-01-29Bibliographically approved

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Boersma, Katja

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