Risk and resilience in chronic pain: anxiety and self-efficacy as mediators in the relationship between pain intensity and disability

Abstract Background Chronic pain in all its forms and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is considered a world level crisis. Chronic non-specific low back pain contributes a significant proportion of chronic pain. Specific psychosocial factors and their influence on reported disability in a chronic non-specific low back pain (CNLBP) population was researched. Methods Psychosocial factors examined include fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study examined the mediating role between pain self-efficacy and the specific psychosocial factors with reported disability. The study included 90 participants with CNLBP between 20 and 60 years of age. Participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index to measure fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability, respectively. The study used multivariate regression and mediation analyses. Results The principal finding of the study was a strong inverse relationship between pain self-efficacy and reported disability. Further, pain self-efficacy was considered a statistic mediator for all psychosocial factors investigated within this data set. Pain self-efficacy was strongly considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, adjusting for age and reported pain levels proved to be statistically significant, and it did not alter the role of pain self-efficacy. Conclusion The results identified that pain self-efficacy had a mediating role in the relationship between the specific psychosocial factors of fear, catastrophizing, and depression and reported disability. Pain self-efficacy plays a more significant role in the relationships between specific psychosocial factors and reported disability with CNLBP than previously considered.

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The Relationship Between Perceived Burdensomeness and Psychosocial Adjustment to Illness in Patients with Chronic Pain: A Mediating Role of Pain Self-Efficacy

Jundishapur Journal of Chronic Disease Care ◽

10.5812/jjcdc.99068 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Esmaeil Sadri Damirchi ◽

Shahriar Dargahi ◽

Nader Ayadi ◽

Davod Fathi

Keyword(s):

Chronic Pain ◽

Direct Effect ◽

Psychosocial Adjustment ◽

Self Efficacy ◽

Pearson Correlation ◽

Perceived Burdensomeness ◽

Mediating Role ◽

Adjustment To Illness ◽

The Relationship

Background: The majority of patients living with chronic pain faces several challenges; therefore, factors affecting their adaptation to the disease to provide appropriate therapeutic methods and meditation and relaxation therapy should be identified. Objectives: The present study aimed at investigating the relationship between perceived burdensomeness and psychosocial adjustment, and the mediating role of pain self-efficacy. Methods: This descriptive correlational study was conducted on 240 patients with chronic pain referred to the orthopedic centers in Ardabil in 2019 selected by convenience sampling. Psychosocial Adjustment to Illness Scale, Pain Self-efficacy Questionnaire, and Interpersonal Needs Questionnaire were used for data collection. Also, Pearson correlation and multiple regressions were used for data analysis. Data were analyzed using SPSS V. 19 and AMOS V. 21. Results: The findings confirmed the negative and direct effect of perceived burdensomeness (β = -0.11 and P < 0.01), as well as the positive and direct effect of pain self-efficacy (β = 0.86 and P < 0.01) on psychosocial adjustment. On the other hand, perceived burdensomeness (β = -0.32, P < 0.01) had a negative and direct effect on pain self-efficacy. The indirect effect of perceived burdensomeness and pain self-efficacy on psychosocial adjustment to illness was also confirmed. Conclusions: According to the findings of the present study, it can be concluded that the feelings of pain self-efficacy mediate the relationship between perceived burdensomeness and psychosocial adjustment in patients with chronic pain. That can also be important for the patient and their caregivers in relation to other chronic illnesses. Chronic diseases can also affect patients and their caregivers.

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Lack of Evidence for Age Differences in Pain Beliefs

Pain Research and Management ◽

10.1155/1997/523815 ◽

1997 ◽

Vol 2 (1) ◽

pp. 19-28 ◽

Cited By ~ 13

Author(s):

Lucy Gagliese ◽

Ronald Melzack

Keyword(s):

Chronic Pain ◽

Age Differences ◽

Self Efficacy ◽

The Elderly ◽

Pain Experience ◽

Pain Beliefs ◽

Self Assessments ◽

Normal Ageing ◽

The Relationship

OBJECTIVE: To assess, in two studies, whether there are any age differences in beliefs about the role of psychological, organic and ageing factors in the experience of chronic pain.SUBJECTS: Healthy adults free from chronic pain ranging in age from 18 to 86 years (first study); adults with chronic pain due to arthritis, fibromyalgia or other rheumatological disorders ranging in age from 27 to 79 years (second study).MATERIALS: In both studies, subjects completed the Pain Beliefs Questionnaire which was modified to measure beliefs about the relationship between pain and ageing. In addition, subjects completed various self-assessments of health, pain intensity and depression. Those with chronic pain also completed the Arthritis Self-Efficacy Scale.RESULTS: There was no evidence of any age differences in beliefs about pain in either the pain-free or chronic pain samples. There was some evidence that elderly patients may report less pain, but there were no age differences found on measures of depression or self-efficacy.CONCLUSIONS: The elderly were no more likely than younger persons to associate pain with the normal ageing process than with organic factors such as tissue damage, nor were they more likely to deny the importance of psychological factors to the pain experience.

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The impact of pain anxiety on chronic pain among elders

European Psychiatry ◽

10.1016/s0924-9338(11)72711-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1006-1006 ◽

Cited By ~ 1

Author(s):

M. Tsatali ◽

M. Gouva

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Statistical Significance ◽

Well Being ◽

Linear Regression Method ◽

Pain Anxiety ◽

Education Levels ◽

Geriatric Pain ◽

Pain Anxiety Symptoms Scale ◽

The Impact

IntroductionPain is a complex and multifacial phenomenon, which interferes in almost every person's life, while in case it turns into chronic, can cause a significant disturbance in individual's physical, psychological and social sphere. That means the intense communication and interaction between ache biome, living conditions and state of health. Cognitive factors play a significant role on the recurrent dysphoria levels, while cognitive functions participate actively in pain intensity, sense of disability and medicine response.AimEstimate the possible significance between pain anxiety and pain intensity.Materials and methodsEighty six elders suffering from various types of chronic pain were examined by the Pass-20 (Pain Anxiety Symptoms Scale) scale, and GPM (Geriatric Pain Measure), while the results were assessed by SPSS 14 and specifically the Linear Regression method.ResultsIt was found statistical significance between the four sub-scales and the presence and existence of chronic pain among participants. Specifically the first subcale (avoidance of pain) was linked with the intensity of pain (p = ,00), the second scale (fearfull thinking) was associated with the prevalence of pain and the gender (p = ,014), the third scale (cognitive anxiety) showed a statistic significance with GPM results and education levels (p = ,00) and the forth scale (psychological responses) was found to affect the pain sense, while it was depended by gender (p = ,0015).DiscussionAmong elders pain anxiety can deteriorate the pain sense affecting the general well-being. For that reason non-pharmacological interventions can be very helpful both for the patient and clinician.

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(262) Pain-related injustice perception, but not catastrophizing, partially mediates the relationship between pain intensity and pain outcomes in children with chronic pain

Journal of Pain ◽

10.1016/j.jpain.2017.02.154 ◽

2017 ◽

Vol 18 (4) ◽

pp. S41

Author(s):

M. Miller ◽

A. Williams ◽

E. Scott ◽

Z. Trost ◽

A. Hirsh

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Pain Outcomes ◽

The Relationship

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Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members

European Journal of Pain ◽

10.1016/j.ejpain.2008.11.016 ◽

2010 ◽

Vol 14 (1) ◽

pp. 71-76 ◽

Cited By ~ 37

Author(s):

Joanna L. McParland ◽

Christina Knussen

Keyword(s):

Chronic Pain ◽

Psychological Distress ◽

Pain Intensity ◽

Support Group ◽

Just World Beliefs ◽

Just World ◽

Group Members ◽

Relationship Of ◽

The Relationship

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Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription

Anesthesiology ◽

10.1097/aln.0000000000001656 ◽

2017 ◽

Vol 127 (1) ◽

pp. 136-146 ◽

Cited By ~ 21

Author(s):

Yasamin Sharifzadeh ◽

Ming-Chih Kao ◽

John A. Sturgeon ◽

Thomas J. Rico ◽

Sean Mackey ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Pain Treatment ◽

Pain Catastrophizing ◽

Tertiary Care ◽

Treatment Center ◽

Women Patients ◽

Opioid Prescription ◽

Men And Women ◽

The Relationship

Abstract Background Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain. Methods The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety. Results Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men. Conclusions Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically “subthreshold” levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.

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A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v11i1.1647 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Antonia L. Wadley ◽

Tamar Pincus ◽

Michael Evangeli

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Mediation Analysis ◽

Rating Scale ◽

Hiv Stigma ◽

People Living With Hiv ◽

Cross Sectional ◽

Aids Stigma ◽

Living With Hiv ◽

The Relationship

Background: Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.Aim: The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.Setting: The study took place at an HIV clinic in Johannesburg, South Africa.Methods: Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.Results: In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).Conclusion: Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.

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Assessment of Pain Anxiety, Pain Catastrophizing, and Fear of Pain in Children and Adolescents With Chronic Pain: A Systematic Review and Meta-Analysis

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsx103 ◽

2017 ◽

Vol 43 (3) ◽

pp. 314-325 ◽

Cited By ~ 22

Author(s):

Emma Fisher ◽

Lauren C Heathcote ◽

Christopher Eccleston ◽

Laura E Simons ◽

Tonya M Palermo

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Pain Intensity ◽

Pain Catastrophizing ◽

Meta Analysis ◽

Anxiety And Depression ◽

Generalized Anxiety ◽

Evidence Based ◽

Fear Of Pain ◽

Pain Anxiety

Abstract Objective To conduct a systematic review of pain anxiety, pain catastrophizing, and fear of pain measures psychometrically established in youth with chronic pain. The review addresses three specific aims: (1) to identify measures used in youth with chronic pain, summarizing their content, psychometric properties, and use; (2) to use evidence-based assessment criteria to rate each measure according to the Society of Pediatric Psychology (SPP) guidelines; (3) to pool data across studies for meta-analysis of shared variance in psychometric performance in relation to the primary outcomes of pain intensity, disability, generalized anxiety, and depression. Methods We searched Medline, Embase, PsycINFO, and relevant literature for possible studies to include. We identified measures studied in youth with chronic pain that assessed pain anxiety, pain catastrophizing, or fear of pain and extracted the item-level content. Study and participant characteristics, and correlation data were extracted for summary and meta-analysis, and measures were rated using the SPP evidence-based assessment criteria. Results Fifty-four studies (84 papers) met the inclusion criteria, including seven relevant measures: one assessed pain anxiety, three pain catastrophizing, and three fear of pain. Overall, five measures were rated as “well established.” We conducted meta-analyses on four measures with available data. We found significant positive correlations with the variables pain intensity, disability, generalized anxiety, and depression. Conclusion Seven measures are available to assess pain anxiety, pain catastrophizing, and fear of pain in young people with chronic pain, and most are well established. We present implications for practice and directions for future research.

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