Clin J Pain. 2003 Jan-Feb; 19(1): 31-8.

Factors associated with willingness to try different pain treatments for pain after a spinal cord injury.

Haythornthwaite JA, Wegener S, Benrud-Larson L, Fisher B, Clark M, Dillingham T, Cheng L, DeLateur B.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. jhaytho1@jhmi.edu

OBJECTIVE: To develop and establish the psychometric properties of a pain treatment willingness scale and identify factors associated with willingness to try specific pain treatments for spinal cord injury (SCI)-related pain. DESIGN: As part of a larger study, a questionnaire was designed to assess willingness to use various pain medications and other types of pain treatments. This questionnaire, which included measures of pain severity, pain interference, mood, hope, and current use of pain treatments, was completed by persons with SCI recruited through the mail or in person. SUBJECTS: One hundred fifteen persons completed the questionnaire (35% response rate). Seventy-two percent of the participants were men, mean age was 49.1 years, and average time elapsed since injury was 8 years. RESULTS: Factor analysis indicated two factors-willingness to use opioids and willingness to use nonpharmacological treatment (i.e., physical therapy, relaxation methods and stress management, and alternative medicine). Internal consistency and convergent and divergent validity were established. Persons experiencing SCI-related pain were more willing to use pain treatments than those without current pain, and those who were currently using opioids reported greater willingness to use that treatment. Persons who reported SCI-related pain were more willing to use nonpharmacological treatments than opioid medications. Finally, participants demonstrated different degrees of willingness to use an opioid medication based on its name (i.e., "narcotic," "codeine," "morphine," "methadone"). CONCLUSIONS: Willingness to use a specific pain treatment may be a key factor mediating the behavior of using that specific treatment. Assessment of patient attitudes toward various treatments options, particularly regarding opioid medications, is warranted to optimize treatment adherence. Once the factors that determine these attitudes are identified, interventions to increase willingness to use nonpharmacological or opioid treatments can be designed and evaluated.