Improving treatment engagement and adherence in patients with chronic pain

Chronic pain disorders affect millions of Americans. While physical factors play a role in these disorders, psychological treatment provided within a CBT framework is frequently the treatment of choice. The efficacy of psychologically oriented treatment for chronic pain is well supported and treatment is widely available; however, many patients fail to benefit because they choose not to participate in treatment or drop out of treatment early. Primary factors affecting patients' willingness to engage with and adhere to psychologically oriented treatment of chronic pain include patients' doubts regarding the credibility of psychologically oriented treatment, patients' negative reactions to being referred for psychologically oriented treatment, and problems associated with the therapeutic relationship. This dissertation provides a client-centered framework for understanding chronic pain patients' reluctance to engage in and adhere to psychologically oriented treatment of chronic pain and presents an overview of the fundamental principles and skills of motivational interviewing (MI), a client-centered and directive clinical method for facilitating health behavior change. Specific recommendations are provided for how MI might be provided within a single-session format as a means of enhancing chronic pain patients' willingness to engage with and adhere to psychologically oriented treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)