— How chronic pain patients decide whether to consider a treatment change

Falzer PR, VA Connecticut Healthcare System; Fraenkel L, VA Connecticut Healthcare System;

Objectives:
Many chronic pain patients who are receiving treatment but continue to experience significant pain tend to decline their practitioners’ recommendations to switch to a more effective treatment. While this tendency is commonly attributed to fear of side effects, loss of control, or risk aversion, we proposed that it results from how patients perceive their illness and assess their future prospects. Drawing on theories of illness perception and patient decision making, the study examined two hypotheses: 1) Considering a treatment change is associated with specific illness-related beliefs, and 2) willingness to consider a treatment change is directly related to the perceived discrepancy between a patient’s current health state and their desired future state.

Methods:
A questionnaire was administered to 139 volunteer, symptomatic, chronic pain patients at Department of Veterans Affairs medical centers. Participants were asked about their symptom severity and physical functioning, and whether they were currently considering a change in their current pain treatment. Their beliefs about illness and treatment were assessed by a 20-item illness perception questionnaire.

Results:
Beliefs related to illness severity, emotional representation, and future expectation were significantly associated with patients’ considering a treatment change. 35% of patients were considering a treatment change overall, but the percentage ranged from 20 to 70, depending on the number of highly discrepant beliefs. Using generalized linear modeling, the relationship between these percentages and the number of discrepant beliefs was significant and remained significant after pain symptom severity and functioning were entered as covariates.

Implications:
The willingness of chronic pain patients who are receiving treatment but remain symptomatic to consider a treatment change is associated with their beliefs about their illness, current condition, and future prospects. These beliefs tap a broad domain of experience and enable patients to evaluate the discrepancy between their current and desired future health states.

Impacts:
Subject to its limitations, we believe the study's findings and procedures can assist practitioners to identify the illness-related beliefs of their patients that have a bear significantly on their decision making processes, especially their willingness to consider a treatment change.