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(406) Nonspecific factors in complementary/alternative medicine (CAM) and conventional treatments: Predictive validity of the Healing Encounters and Attitudes Lists (HEAL) in persons with ongoing pain

      Treatment outcomes are influenced not only by the specific actions of a modality, but also by nonspecific factors such as the patient’s views of the therapeutic context. PROMIS® methodology was used to develop the Healing Encounters and Attitudes Lists (HEAL), a set of measures of nonspecific factors that may influence healing, such as perceptions of the provider, expectations of treatment, spirituality and positive outlook. In this report, we present information on predictive validity of the HEAL in a sample of persons initiating treatment for chronic pain. The HEAL measures and the PROMIS Pain Interference scale were administered at baseline and six weeks later to 207 persons with chronic back (37%), neck (12%), or both back and neck pain (51%) who had recently started a CAM (n=99) or conventional medicine (n=108) treatment. Participants also completed the clinical global impression of improvement (CGI) at six weeks. The average age of participants was 50 (sd=16), 73% were female, 27%% were non-white or multiracial, and 47% had less than a 4-year college degree. The most frequently reported treatments were chiropractic (35.7%), physical therapy (24%), medications (11%), and massage/bodywork (7.2%). In the overall sample, pain interference was reduced significantly from baseline to the 6-week assessment [t(187) = 7.81, p<0.001]. On the CGI, 70% reported improvement (“somewhat better” or “much better”) at 6 weeks. In regression models, baseline HEAL Treatment Expectancy, Spirituality, and Positive Outlook accounted for 17.3% of the variance in outcome in 6-week Pain Interference among CAM patients, whereas HEAL Spirituality accounted for 9.3% of the variance in outcome in 6-week Pain Interference among conventional medicine patients. For both CAM and conventional medicine participants, baseline HEAL Treatment Expectancy predicted CGI improvement at 6 weeks: 8.2% and 5.7% of the variance, respectively. Nonspecific factors are important to measure, as they influence treatment outcomes. Supported by NIH-NCCIH.