Curran, C.; (2007) Cognitive-Behavioural Therapy for persistent pain: does adherence affect outcome at one-month follow-up. Doctoral thesis , University of London.

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Abstract

Background: The varied effectiveness of Cognitive-Behavioural Therapy (CBT) and other psychological therapies in the treatment of persistent pain has led researchers to examine a range of factors that may predict treatment response. Studies have identified a diverse set of personal (i.e., age, gender, and marital status), specific (i.e., level of depression, treatment expectancy, and catastrophising), and non-specific (i.e., adherence to treatment) variables that appear to be associated with treatment outcome, although few with any consistency. This review summarises the available literature on predictors of outcome for persistent pain and discusses limitations of such studies.;Data Sources and Review Method: The persistent pain literature was examined to identify proposed variables that predict response to multicomponent treatment for persistent pain. PsycINFO and Medline databases were searched spanning articles published from 1990 to 2006 of treatment studies and review articles.;Results: Very few studies that focused on predictors of outcome following CBT for persistent pain in the adult population were found through the database searches. Therefore, in addition, a hand-search of key journals, of reference lists from searched articles, and of relevant books was completed and articles prior to 1990 were consequently included in the review at the author's discretion. All types of persistent pain were included except headache.;Conclusions: Main results: The review showed that of the many personal variables investigated to influence outcome, only socioeconomic status (SES), social support, and applying for compensation or disability pension consistently predicted outcome. Of the specific variables, changes in catastrophising, self-efficacy, pain-related fear, pain tolerance, pain helplessness and perceived disability have each been shown to consistently predict outcome. Few studies were found that had investigated the role of adherence during or after treatment on treatment outcome. Finally, suggestions for future research are discussed.;Keywords: Predictor(s), factor(s), cognitive-behavio(u)ral therapy, chronic pain, persistent pain, treatment outcome.

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