Pain self-management: easier said than done? Factors associated with early dropout from pain self-management in a rural primary care population
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Objective To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low–socioeconomic status population. Design Secondary analysis of retrospective data. Setting Multidisciplinary pain clinic located in an outer regional area of Australia.Subjects One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). Methods Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. Results Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). Conclusions In a rural, low–socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.
This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2018) in accordance with the publisher’s archiving policy