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The cognitive risk profile for pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management.
Clin J Pain 2006; 22(4):332-45CJ

Abstract

OBJECTIVES

An extensive body of research suggests that maladaptive beliefs about chronic pain can have a negative impact on patient adherence and treatment response. A series of studies to develop and validate a clinically-based, self-report instrument for pain beliefs, the Cognitive Risk Profile for Pain (CRPP), was undertaken. We sought to expand the existing body of knowledge for pain beliefs by development of an instrument with a somewhat different content and format than prior pain belief measures, and a primary focus on clinical risk assessment for treatment planning.

METHODS

Test development and evaluation procedures were applied in the initial stages of CRPP development. We report here on a series of studies to evaluate and refine the structure and content of the CRPP, and to establish its internal reliability, concurrent, and criterion validities. A 68-item version of the CRPP was evaluated, including a total risk score and 9 scale scores: philosophic beliefs about pain (PB), denial that mood affects pain (MP), denial that pain affects mood (PM), perception of blame (BL), inadequate support (IS), disability entitlement (DE), desire for medical breakthrough (MB), skepticism of multidisciplinary approach (SM), and conviction of hopelessness (CH). The CRPP was administered to two large samples of chronic pain outpatients (n=499; 125) in conjunction with other self-report scales for pain and associated beliefs, behaviors, and psychopathology. In a final study, treatment outcome measures were obtained for a subsample of chronic pain patients (n=91) to evaluate criterion validity.

RESULTS

Confirmatory factor analyses showed improved fit for the CRPP scale structure after elimination of 15 items. The resulting 53-item CRPP was found to have good internal consistency for the full score (alpha=0.82) and 7 of 9 scales, with moderate consistency for scales BL and MB. Low to moderate scale intercorrelations were found. Correlations with pain and psychosocial measures suggested good construct validity for the majority of individual scales and total score. Results were inconsistent for scale MP. Multivariate analyses of variances (MANOVAs) based on tertile split of total risk scores showed significant main effects across pain, mood, productivity, and sleep ratings at 3 and 6-month treatment follow-ups. Analyses of clinically significant treatment changes (ie, 2 points on a 11-point Numerical Rating Scales) showed significantly higher prevalence of treatment "failures" at 6 months among CRPP high-risk patients, but no significant differences at 3 months.

DISCUSSION

Results provide initial support for the CRPP as a reliable, valid, and useful measure of general cognitive risk for pain management. Results were supportive of the content and reliabilities of the majority of scale scores. Scales for denial of mood impact on pain, perception of blame, and desire for medical breakthrough will require further evaluation. Data indicate an association of CRPP total risk with multidimensional outcome from medical treatment of chronic pain, supporting relevance to treatment planning. The unique content and format of the CRPP may be useful in some clinical pain settings. Possible applications of the CRPP for risk assessment and treatment planning for chronic pain are discussed.

Authors+Show Affiliations

Department of Anesthesiology, Division of Pain , University of Virginia Health System, Charlottesville, VA 22908, USA. ajcook@virginia.eduNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16691085

Citation

Cook, Andrew J., and Douglas E. Degood. "The Cognitive Risk Profile for Pain: Development of a Self-report Inventory for Identifying Beliefs and Attitudes That Interfere With Pain Management." The Clinical Journal of Pain, vol. 22, no. 4, 2006, pp. 332-45.
Cook AJ, Degood DE. The cognitive risk profile for pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management. Clin J Pain. 2006;22(4):332-45.
Cook, A. J., & Degood, D. E. (2006). The cognitive risk profile for pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management. The Clinical Journal of Pain, 22(4), pp. 332-45.
Cook AJ, Degood DE. The Cognitive Risk Profile for Pain: Development of a Self-report Inventory for Identifying Beliefs and Attitudes That Interfere With Pain Management. Clin J Pain. 2006;22(4):332-45. PubMed PMID: 16691085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cognitive risk profile for pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management. AU - Cook,Andrew J, AU - Degood,Douglas E, PY - 2006/5/13/pubmed PY - 2006/7/14/medline PY - 2006/5/13/entrez SP - 332 EP - 45 JF - The Clinical journal of pain JO - Clin J Pain VL - 22 IS - 4 N2 - OBJECTIVES: An extensive body of research suggests that maladaptive beliefs about chronic pain can have a negative impact on patient adherence and treatment response. A series of studies to develop and validate a clinically-based, self-report instrument for pain beliefs, the Cognitive Risk Profile for Pain (CRPP), was undertaken. We sought to expand the existing body of knowledge for pain beliefs by development of an instrument with a somewhat different content and format than prior pain belief measures, and a primary focus on clinical risk assessment for treatment planning. METHODS: Test development and evaluation procedures were applied in the initial stages of CRPP development. We report here on a series of studies to evaluate and refine the structure and content of the CRPP, and to establish its internal reliability, concurrent, and criterion validities. A 68-item version of the CRPP was evaluated, including a total risk score and 9 scale scores: philosophic beliefs about pain (PB), denial that mood affects pain (MP), denial that pain affects mood (PM), perception of blame (BL), inadequate support (IS), disability entitlement (DE), desire for medical breakthrough (MB), skepticism of multidisciplinary approach (SM), and conviction of hopelessness (CH). The CRPP was administered to two large samples of chronic pain outpatients (n=499; 125) in conjunction with other self-report scales for pain and associated beliefs, behaviors, and psychopathology. In a final study, treatment outcome measures were obtained for a subsample of chronic pain patients (n=91) to evaluate criterion validity. RESULTS: Confirmatory factor analyses showed improved fit for the CRPP scale structure after elimination of 15 items. The resulting 53-item CRPP was found to have good internal consistency for the full score (alpha=0.82) and 7 of 9 scales, with moderate consistency for scales BL and MB. Low to moderate scale intercorrelations were found. Correlations with pain and psychosocial measures suggested good construct validity for the majority of individual scales and total score. Results were inconsistent for scale MP. Multivariate analyses of variances (MANOVAs) based on tertile split of total risk scores showed significant main effects across pain, mood, productivity, and sleep ratings at 3 and 6-month treatment follow-ups. Analyses of clinically significant treatment changes (ie, 2 points on a 11-point Numerical Rating Scales) showed significantly higher prevalence of treatment "failures" at 6 months among CRPP high-risk patients, but no significant differences at 3 months. DISCUSSION: Results provide initial support for the CRPP as a reliable, valid, and useful measure of general cognitive risk for pain management. Results were supportive of the content and reliabilities of the majority of scale scores. Scales for denial of mood impact on pain, perception of blame, and desire for medical breakthrough will require further evaluation. Data indicate an association of CRPP total risk with multidimensional outcome from medical treatment of chronic pain, supporting relevance to treatment planning. The unique content and format of the CRPP may be useful in some clinical pain settings. Possible applications of the CRPP for risk assessment and treatment planning for chronic pain are discussed. SN - 0749-8047 UR - https://www.unboundmedicine.com/medline/citation/16691085/The_cognitive_risk_profile_for_pain:_development_of_a_self_report_inventory_for_identifying_beliefs_and_attitudes_that_interfere_with_pain_management_ L2 - http://dx.doi.org/10.1097/01.ajp.0000209801.78043.91 DB - PRIME DP - Unbound Medicine ER -