Cognitive-Motivational Influences on Health Behavior Change in Adults with Chronic Pain

Objective. The primary aim was to assess the psychological factors that influence engagement in health behaviors in individuals with chronic pain using a new measure, the Behavioral Engagement Test for Chronic Pain (BET-CP). A secondary aim was to determine preliminary psychometric properties of the BET-CP. Subjects. Participants were 86 adults with chronic musculoskeletal pain recruited from University of Florida pain clinics and the community. Methods. Participants completed a battery of self-report instruments online, including the BET-CP and measures of related constructs. Items on the BET-CP assessed motivation, self-efficacy, outcome expectations, and the symptom benefit required to engage across four health behaviors: exercise, diet, sleep, and pain self-management (e.g., relaxation and activity pacing). Results. Participants reported modest expectations of pain-related symptom improvement if they practiced the health behaviors (22-26% improvement), but they required twice that (47-54% improvement) to make it worth their while to commit to practicing them. Participants expected to get the most symptom relief from relaxation and activity pacing, but they were most confident and motivated to eat a healthy diet. In a subsample of participants who provided data for psychometric analysis, the BET-CP demonstrated strong test-retest reliability across 7 days and adequate convergent validity. Conclusion. While patients with musculoskeletal pain have outcome expectancies that are nearly in line with research on behavioral pain treatments, their stringent requirements for symptom benefit may impede engagement in the health behaviors recommended for their pain-related symptoms. Additional psychometric study with larger sample sizes is needed to further validate the BET-CP.