American Pain Society's 27th Annual Scientific Meeting (May 8 – 10, 2008): Changes in catastrophizing predict pain ratings in persons with limb loss
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8281 Changes in catastrophizing predict pain ratings in persons with limb loss

May 9, 2008: May 9, 2008
East Hall (Tampa Convention Center)
Susan E. Hofkamp, PhD , Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD
Stephen Wegener, PhD , Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD
Ellen J. MacKenzie, PhD , Department of Health Policy & Management, Johns Hopkins University, Baltimore, MD
Patti Ephraim, MPH , Center for Injury Research & Policy, Johns Hopkins University, Baltimore, MD
Dawn M. Ehde, PhD , Department of Rehabilitation Medicine, University of Washington, Seattle, WA
Rhonda M. Williams, PhD , Department of Rehabilitation Medicine, University of Washington, Seattle, WA
Brendan Klick, MS , Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD
Self-management programs, which are based on cognitive-behavioral theory, have been shown to improve outcomes related to pain and disability in various chronic conditions. One possible mechanism underlying such improvements is reductions in catastrophizing. The results presented here come from secondary analyses of a RCT to assess the effectiveness of a self-management intervention for reducing pain and improving mood and self-efficacy in persons with limb loss. Fifty-two existing Amputee Coalition of America (ACA) support groups were randomized (26 control, 26 intervention) and 227 participants were enrolled in the control group and 275 in the intervention group. The sample included: a) Intervention group – 55% men, mean age = 55.5, 78% white, 95% with at least HS education, median time since limb loss = 4 years; b) control group – 59% men, mean age = 56.9, 79% white, 95% at least HS education, median time since limb loss = 5 years. There were no significant differences between the two groups and they were combined, with group assignment controlled, for these analyses. Linear regression models found significant associations between baseline catastrophizing and post-treatment ratings of lowest pain (b= 0.21, p< .0001) and average pain (b= 0.27, p< .0001). Baseline catastrophizing was associated with pre- to post-treatment changes in lowest pain (b= 0.23, p< .0001) and average pain (b= 0.26, p< .0001). Post-treatment catastrophizing predicted average pain at 3 months post-treatment (b= 0.15, p= .004) and change in average pain from post-treatment to 3 months follow-up (b= 0.15, p= .004). Results demonstrate that as catastrophizing scores increased, pain ratings also increased and improvement in pain ratings were smaller for up to 3 months post-treatment. These data indicate that higher scores on catastrophizing interfered with improvement in pain ratings. The findings support focusing on catastrophizing as a key target for cognitive-behavioral interventions for persons with limb loss.
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