Stages of change in readiness to adopt a self-management approach to chronic pain: the moderating role of early-treatment stage progression in predicting outcome John W. Burns a, * , Beth Glenn b , Ken Lofland c , Stephen Bruehl d , R. Norman Harden e a Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, USA b UCLA Division of Cancer Prevention and Control Research, Los Angeles, CA, USA c Pain and Rehabilitation Center of Chicago, Chicago, IL, USA d Vanderbilt University, Nashville, Tennessee, USA e Rehabilitation Institute of Chicago, Chicago, IL, USA Received 11 January 2005; received in revised form 21 February 2005; accepted 3 March 2005 Abstract Relative readiness to assume a self-management approach to chronic pain can be conceptualised as a stage model. Although both initial stage (precontemplation, action) and changes in attitudes reflecting stage orientation have been shown to predict treatment outcome, the joint contributions of these factors need to be examined. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary pain program, completed the Pain Stages of Change Questionnaire (PSOCQ), subscales of the Multidimensional Pain Inventory, and the Beck Depression Inventory at pre-, mid- and post-treatment. Patients were assigned to stage group (precontemplation or action) based on whether their Precontemplation or Action subscale scores were highest. Results showed that: (a) stage group interacted with pre- to mid-treatment Precontemplation subscale changes to predict mid- to late-treatment pain severity and interference changes such that precontemplation attitude decreases were related to reduced pain and interference only among patients who were already action stage at pre-treatment; (b) stage group interacted with pre- to mid-treatment Action subscale changes to predict mid- to late-treatment interference and activity changes such that action attitude increases were related to reduced interference and increased activity only among patients at the action stage at pre- treatment; (c) pre- to mid-treatment decreases in depression did not account for these effects. Results suggest that any advantage enjoyed by patients with predominant action attitudes at pre-treatment may be enhanced by consolidating a pain self-management approach during treatment. In contrast, late-treatment gains of patients initially taking a predominant precontemplation stance were unaffected by their degree of early-treatment attitude changes. q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Keywords: Pre-treatment stage; Change in stage orientation; Lagged relationships; Outcome Kerns and colleagues (Kerns and Rosenberg, 2000; Kerns et al., 1997) argue that the degree to which chronic pain patients are prepared to adopt, or have already adopted a ‘self- management’ approach to pain affects whether they benefit from multidisciplinary pain treatment. Adapting the trans- theoretical model (Prochaska and DiClemente, 1983), they propose that patients’ readiness to assume a self-management stance may be conceptualised in terms of stages of change (Kerns et al., 1997). Precontemplative patients embrace beliefs that chronic pain is a medical condition and that professionals should relieve it, whereas action stage patients accept the need to self-manage chronic pain, actively seek new skills and enrich existing ones. Action stage patients have attitudes consistent with the self-management orien- tation promoted by multidisciplinary pain programs, and so benefit from participation. Those in a precontemplative stage, however, attempt to avoid entering such programs, do not comply with treatment regimens, or terminate because Pain 115 (2005) 322–331 www.elsevier.com/locate/pain 0304-3959/$20.00 q 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2005.03.007 * Corresponding author. Tel.: C1 847 578 8751. E-mail address: john.burns@rosalindfranklin.edu (J.W. Burns).