Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients.

Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if changes were significant. Z-scores were then calculated. Pearson product moment correlations were examined to test the association between changes in self-efficacy and changes in the other variables of interest. Patients in this study reported significant improvements in all scores postprogram. Self-efficacy, pain-intensity, pain-related disability, and symptoms of depression can be changed through participation in a nurse-led outpatient CBT program. In concert with results from other research on CBT pain programs this study provides further evidence that reduction in suffering and improved sense of well-being is possible even for people who have experienced pain for many years.

From chronic pain patient to peer: benefits and risks of volunteering.

Peer volunteers have been used as cost-effective adjuncts to professional services in other settings and populations, but not a heterogeneous sample of patients with chronic pain. This study evaluated the transition from "patient" to "peer," identifying possible benefits or harm associated with volunteering. Peers provided descriptive data and questionnaires, including measures of pain, disability, self-efficacy, and depression before and after three periods: as a patient, during training, and while volunteering. Average pain intensity scores declined while participants were patients (7.1 to 4.2), rose slightly (5.8) before training, and dropped again after training and volunteering (4.3 and 3.6, respectively). A similar pattern was noted for disability. Depression scores continued to decline after initially dropping, and self-efficacy scores remained stable after the initial 40% rise as a patient. Two themes, "making a connection" and "a sense of purpose," emerged from the narrative data. Descriptive data provided further support that volunteering benefited both patients and peers. This study supports the viability of using peer volunteers for clinical or research endeavors. Improvements in pain, disability, and depression were reported immediately after training and after volunteering for several months without evidence of harm. Despite encountering challenges, the rewards of this altruistic endeavor outweighed any frustrations experienced by volunteers with chronic pain.

Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.

To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. Questionnaires from 126 chronic pain patients (without prior depression) were reviewed from three pain clinics. Hypothesized and alternate models were tested using separate regression equations to identified models which best fit these data. Regression analysis supported that self efficacy partially mediates the relationship between pain intensity and disability. This model accounted for 47% of the explained variance in disability (P < 0.001). Six additional variables that were significantly related to disability in preliminary analysis, added to the explained variance in disability (R2 = 0.56), with gender and pain location paths remaining significant. In separate regression analyses, disability was found to partially mediate the relationship between pain intensity and depression (b = 0.47-0.33). This model accounted for 26% of the explained variance in depression. The addition of self efficacy to this model supported it as a stronger mediator (R2 = 0.32), and suggested that support for disability as a mediator of depression was a spurious finding. Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain. Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.