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Motivational and behavioural models of change: A longitudinal analysis of change among men with chronic haemophilia-related joint painBackground: Motivational and behavioral models of adjustment to chronic pain make different predictions about change processes, which can be tested in longitudinal analyses. Methods: We examined changes in motivation, coping and acceptance among 78 men with chronic hemophilia-related joint pain. Using cross-lagged regression analyses of changes from baseline to 6 months as predictors of changes from 6 to 12 months, with supplementary structural equation modelling, we tested two models in which motivational changes influence behavioral changes, and one in which behavioral changes influence motivational changes. Results: Changes in motivation to self-manage pain influenced later changes in pain coping, consistent with the motivational model of pain self-management, and also influenced later changes in activity engagement, the behavioral component of pain acceptance. Changes in activity engagement influenced later changes in pain willingness, consistent with the behavioral model of pain acceptance. Conclusions: Based on the findings, a combined model of changes in pain self-management and acceptance is proposed, which could guide combined interventions based on theories of motivation, coping and acceptance in chronic pain.
Pain coping and acceptance as longitudinal predictors of health-related quality of life among people with haemophilia-related joint painInterventions based on coping and acceptance can be adapted for people with different painful conditions. Evidence about baseline characteristics that predict improved outcomes is informative for matching people to interventions, whereas evidence about changes that predict improved outcomes is informative about the processes that interventions should target. Participants in a low-intensity program to promote self-management of hemophilia-related chronic joint pain (n=101) reported pain intensity, coping, acceptance and quality of life at baseline and 6-month follow-up. Baseline and change measures of pain intensity, coping and acceptance were used to predict follow-up quality of life, taking account of baseline quality of life. Changed (reduced) pain intensity predicted better physical quality of life, independently of age, hemophilia severity, baseline pain intensity and baseline physical quality of life. Lower baseline passive coping and changed (increased) pain acceptance predicted better mental quality of life, independently of age, severity, and baseline mental quality of life. Increased activity engagement but not pain willingness predicted better mental quality of life when pain acceptance was decomposed. Changed (reduced) negative thoughts also predicted better mental quality of life when separate acceptance subscales were used. Active pain coping did not predict physical or mental quality of life. Initially high levels of passive coping may be an obstacle to improving mental quality of life. Acceptance rather than coping may be a more useful behavioral change target, but more research is needed about the meanings and therapeutic implications of different elements of pain acceptance.
Pain coping, pain acceptance and analgesic use as predictors of health-related quality of life among women with primary dysmenorrheaPrimary dysmenorrhea causes menstrual pain that affects women’s quality of life (QoL) and analgesics are only moderately effective. Pain coping and pain acceptance influence QoL among people affected by other chronic pain conditions, so we examined pain coping, pain acceptance and analgesic use as predictors of QoL among women with primary dysmenorrhea. 145 women with primary dysmenorrhea completed an online survey including the Menstrual Symptoms Questionnaire (MSQ), the Coping Strategies Questionnaire (CSQ), the Chronic Pain Acceptance Questionnaire (CPAQ-8), questions about analgesic use, and the Short Form-12 (SF-12), a measure of physical and mental health-related QoL. In multiple regression, pain acceptance predicted better physical and mental QoL, whereas pain coping did not predict mental or physical quality of life. Being married or cohabiting and menstrual pain that was less severe and shorter in duration predicted better physical QoL, and those effects were mediated by pain acceptance. Being older at the onset of painful periods predicted better mental QoL and that effect was also mediated by pain acceptance. More severe menstrual pain and congestive rather than spasmodic dysmenorrhea predicted worse mental QoL but those effects were not mediated by other factors. Analgesic use did not predict physical or mental QoL. The results show the impact that menstrual pain has on women’s quality of life, and suggest that initiatives to increase pain acceptance among women with menstrual pain are worthwhile. More research is needed to understand more fully the factors that influence health-related quality of life among women with menstrual pain.
What is acceptance, and how could it affect health outcomes for people receiving renal dialysis?Renal dialysis is a life-saving treatment for end-stage renal disease (ESRD) but is burdensome, invasive and expensive. Patients’ experiences of dialysis and the outcomes of their treatment could potentially be improved by focusing on ‘acceptance’. However, the concept of acceptance has been used in different ways. This article examines ways that acceptance has been conceptualised in research on chronic illness generally and ESRD specifically, and makes proposals for research to understand better what acceptance means for people with ESRD. The aim is to assist the development of acceptance-related measures and interventions to support people with ESRD.