Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain.

According to the cognitive-behavioral model of chronic pain, patient beliefs about their chronic pain influence their behavioral and psychological functioning. Previous correlational and longitudinal studies have supported this hypothesis. However, since previous research has relied almost exclusively on patient self-report to assess both beliefs and functioning, shared method variance may explain some of the relationships found. The aim of the current study was to replicate and extend previous research on the relationship between pain beliefs and patient functioning and behavior by assessing the latter based on three sources of information: patient report, spouse report and direct observation. A total of 121 patients with chronic pain completed self-report measures of beliefs and function. Their spouses completed a measure of patient pain behavior, and both participated in a protocol, from which patient pain behaviors were coded by trained observers. Previously reported relationships between patient beliefs about pain and patient-reported functioning were replicated. Measures of patient beliefs were more strongly associated with self-report measures of pain behaviors and functioning than with spouse and observer ratings of patient pain behaviors. However, significant associations between patient beliefs and both spouse- and observer-reported frequency of patient pain behaviors were found. These findings argue for the generalizability of the relationship found between patient beliefs and patient behaviors across assessment domains, and for the continued application of the cognitive-behavioral model to the understanding of patient adjustment to chronic pain.