Motivation and Adherence in the Management of Chronic Pain
Robert D. Kerns VA Connecticut Healthcare System and Yale University
Laura A. Bayer Yale University
James C. Findley Yale University
The past 20 years have seen significant advances in the development of effective medical, psychological, rehabilitative, and multimodal approaches to the management of chronic pain (cf. Cohen & Campbell, 1996). In the psychological domain alone, well-controlled studies have demonstrated the effectiveness of a broad array of treatment approaches ( Gatchel & Turk, 1996). Despite a growing body of research that encourages optimism in the ability to provide relief for individuals suffering from chronic pain and associated disability and distress, it is also clear that there are many individuals who fail to be successfully engaged in these treatments, or who relapse ( Turk & Rudy, 1991). Jensen ( 1996), in particular, has noted that there are many possible explanations for these shortcomings. Motivation to engage in treatment and adherence to treatment recommendations and prescriptions are factors that have been particularly highlighted in discussions of this issue ( Turk, Meichenbaum, & Genest, 1983).
Implicit in the belief that any treatment is effective is an assumption that the individuals receiving the treatment are motivated to engage in the treatment and will follow the specific recommendations of the health care provider. However, available data regarding patients' adherence to treatment prescriptions indicate that up to 80% of patients may be nonadherent at some point during their treatment ( Dunbar-Jacob, Burke, & Puczynksi, 1995). Problems with adherence have been particularly noted for prescriptions for medication, exercise, smoking cessation, and diet for patients with a wide range of chronic medical conditions such as diabetes,