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      Treatment Expectations Towards Different Pain Management Approaches: Two Perspectives

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          Abstract

          Purpose

          Accumulating evidence suggests an association between patient expectations and treatment success across various types of pain treatments. Expectations among treatment caregivers, however, are often neglected. Despite international treatment guidelines, only a small minority of chronic pain patients undergo psychological interventions. Therefore, our aim was to explore expectations among treatment receivers and caregivers especially concerning their attitudes towards psychological pain treatments.

          Methods

          Two hundred ten (potential) treatment receivers (n=85 individuals suffering from chronic low back pain (CLBP); n=125 healthy controls) and 237 caregivers (n=75 physicians; n=64 psychotherapists; n=98 physiotherapists) provided ratings of expected treatment success for standardized vignettes describing patients suffering from CLBP and undergoing a pharmacological, psychological, or multimodal pain management program.

          Results

          Individuals suffering from CLBP generally had lower treatment expectations than healthy controls. Both psychotherapists and physicians had higher treatment expectations from their own individual treatment approach. All participants expected the multimodal approach to be most effective. The psychological approach was expected to be more effective than the pharmacological approach – except for the physicians, who expected both treatment approaches to be equally effective.

          Conclusion

          There is an urgent need to clarify, under which circumstances and how patient expectations can be altered among individuals suffering from CLBP. Our results appear to encourage the implementation of multimodal and psychological pain management approaches across various settings. We invite clinicians to reflect whether their own expectations are in line with the recommendations in international treatment guidelines.

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          Most cited references 19

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          Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies ☆

          Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect “real world” phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a “hybrid” of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to “real life” behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians’ diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations
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            Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.

            Patients' initial beliefs about the success of a given pain treatment are shown to affect final treatment outcome. The Credibility/Expectancy Questionnaire (CEQ) has recently been developed as measure of treatment credibility and expectancy. The objectives of this study were (1) to investigate the factor structure of the CEQ in a sample of chronic low back pain (CLBP) patients by means of a confirmatory factor analysis, (2) to examine the association between treatment credibility and expectancy and patient characteristics, and (3) to assess whether treatment expectancy and credibility are associated with the outcome of rehabilitation treatment. CLBP patients (n=167) were randomized to either active physical therapy (n=51), cognitive-behavioral therapy (n=57), or a combination therapy (n=59), and completed the CEQ after a careful explanation of the treatment rationale. Confirmatory factor analysis supported the 2-factor structure (credibility/expectancy) of the CEQ. Lower credibility was associated with higher pain-related fear and lower internal control of pain, and lower expectancy with higher levels of pain-related fear and no radiating pain. Multiple linear regression analyses revealed that after controlling for age, sex, treatment center, pain-intensity at baseline, duration of disability, and irrespective of the treatment offered, expectancy was significantly associated with disability and satisfaction. Credibility was significantly associated with patient-specific symptoms and satisfaction. For global perceived effect, treatment expectancy was predictive in active physical therapy only, and treatment credibility was a significant predictor in combination therapy only. Although the associations found were low to modest, these results underscore the importance of expectancy and credibility for the outcome of different active interventions for CLBP and might contribute to the development of more effective treatments.
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              A Short Version of the Pain Anxiety Symptoms Scale (PASS-20): Preliminary Development and Validity

              BACKGROUND: Research has shown significant relations between fear and avoidance of pain and the suffering and disability of chronic pain. Effective measurement tools have formed the foundation for studying these relations. METHODS: The present article describes the initial development and validation of the PASS-20, a short form version of the Pain Anxiety Symptoms Scale (PASS). Like the original inventory, the PASS-20 measures fear and anxiety responses specific to pain. Items were selected for the short version based on item variance, item intercorrelation and reliability analyses. RESULTS: The PASS-20 shows strong internal consistency, reliability, and good predictive and construct validity. Item reduction appears to result in minimal shrinkage of validity correlations. CONCLUSIONS: Overall, the results suggest that the short form retains adequate psychometric properties. Possible research and clinical implications for the PASS-20 include more efficient screening during evaluations of patients with chronic pain, and use when the time or effort needed for the full version is prohibitive.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                09 July 2020
                2020
                : 13
                : 1725-1736
                Affiliations
                [1 ]Department of Clinical Psychology and Psychotherapy, University Koblenz - Landau , Landau 76829, Germany
                [2 ]Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg , Marburg 35032, Germany
                Author notes
                Correspondence: Lea Schemer Department of Clinical Psychology and Psychotherapy, University Koblenz – Landau , Ostbahnstraße 10, Landau76829, GermanyTel +49 6341 280-35627 Email schemer@uni-landau.de
                Article
                247177
                10.2147/JPR.S247177
                7358092
                © 2020 Schemer et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 2, References: 30, Pages: 12
                Categories
                Original Research

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