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Am Fam Physician. 2000;62(11):2519-2520

Research has documented a positive relationship between a person's perceived sense of control and that person's health. The two main types of health locus of control are internal, which reflects a belief in personal control over behavior, and external, characterized as a belief that chance or powerful others have control. Patients with chronic pain who have an internal locus of control are more likely to describe their pain as being less frequent and severe. They also have more effective pain control strategies than patients with an external locus of control. Coughlin and associates evaluated the effectiveness of a multidisciplinary approach in changing patients' locus of control and then evaluated the impact of this change on their ability to manage chronic pain.

Patients with chronic nonmalignant pain who were treated at a chronic pain management center were eligible for the study. Those who met the study criteria completed the Pain Locus of Control Scale and the Survey of Pain Attitudes subscale before and after the four-week outpatient pain program. The 40-hour-per-week program included reduction of narcotic medications, daily exercise, relaxation and coping skills training, and cognitive behavior therapy.

Patients increased their perception of personal control over their pain following participation in the program. In addition, their perception of the role of external controls, such as fate or powerful others, abated by the end of treatment.

The authors conclude that a multidisciplinary approach to the management of chronic pain can alter patients' beliefs about pain and change their locus of control. Helping patients adopt an internal locus of control over pain is essential for successful treatment.

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