Article Text

SP0078 Cognitive Mechanisms of Change in Multidisciplinary Treatment of Patients with Chronic Widespread Pain
  1. A. De Rooij
  2. on behalf of Working Group: Michiel R. de Boer, Marike van der Leeden, Leo D. Roorda, Martijn P.M. Steultjens and Joost Dekker
  1. Amsterdam Rehabilitation Research Center | Reade, Amsterdam, Netherlands


Background Multidisciplinary treatment programs are recommended in patients with CWP and its associated problems. Multidisciplinary treatment in CWP addresses a variety of cognitive mechanisms. However, the cognitive mechanisms of change in the multidisciplinary treatment of patients with chronic widespread pain (CWP) are only partially understood.

Objective To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of the multidisciplinary treatment in patients with chronic widespread pain (CWP).

Methods Data were used from baseline, 6 months and 18 months follow-up of a prospective cohort study of 120 CWP patients who completed a multidisciplinary pain management treatment. Longitudinal relationships were analyzed between changes in cognitions and outcome, using generalized estimated equations. Outcome domains included: pain, interference of pain in daily life, depression, and global perceived effect. Cognitive domains included 1) negative emotional cognitions; negative and emotional thoughts that hinder adjustment to chronic pain, 2) active cognitive coping; cognitive efforts of a person to manage or undo the negative influence of pain, and 3) control and chronicity beliefs; thoughts and expectations about the controllability and chronicity of the illness.

Results Improvements in negative emotional cognitions were associated with improvements in all outcome domains, in particular with improvement in interference of pain with daily life and depression (between baseline and 6 months and 6 and 18 months). Improvements in active cognitive coping were associated with improvements in interference of pain in daily life (between baseline and 6 months). Finally, improvements in control and chronicity beliefs were associated with improvements in pain and depression (between 6 and 18 months).

Conclusions Improvement in negative emotional cognitions seems to be a key mechanism of change of multidisciplinary treatment in CWP. Improvement of active cognitive coping and improvement of control and chronic timeline beliefs may constitute mechanisms of change as well, although the evidence is less strong.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.6214

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