Activity Patterns and Functioning. A Contextual–Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

Abstract

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

“…There was also no direct effect of walking on mental fatigue. Although there are a number of professionals who recommend physical therapy as a strategy to alleviate mental fatigue [ 45 ], the results obtained here indicate that in patients with fibromyalgia, walking without having certain cognitive abilities has no effect on mental fatigue. This could mean that for these women to be able to perceive walking as beneficial for mental clearing, they need to possess various cognitive processing skills (i.e., cognitive defusion and acceptance of chronic pain), and that it is not enough to manage a single cognitive ability or none at all.…”

The Role of Walking in the Relationship between Catastrophizing and Fatigue in Women with Fibromyalgia

“…In contrast, Lukkahatai et al [ 28 ] revealed that fatigue was associated with several symptoms and psychological factors, including pain catastrophism. Our results suggest that the discrepancy in findings might be because catastrophism has been studied in a global and homogenous manner, and its different components have not been analyzed separately [ 24 , 25 , 54 ]. In fact, our findings show no significant results for catastrophism as a general construct but did find differential results when each dimension is studied separately.…”

“…The results are discussed in the context of the psychological flexibility model and personalized interventions. Furthermore, the fact that these results were not found in relation to helplessness shows how complex catastrophism truly is [ 52 ] and the possibility that the different components involved do not have the same role [ 25 , 52 , 53 , 54 ] as has been suggested in recent studies [ 24 ]. Therefore, it is important that future studies focus on catastrophism take into account specifically all its components, not in a general manner, as has been done in most studies.…”

“…These preliminary results suggest that helplessness is not a variable of interest in the prediction of fatigue when walking is included and disability taken into account. Data also show the heterogeneity of the concept of catastrophism [ 24 , 55 ]. Therefore, although it would be necessary to carry out exhaustive analyses regarding the role of helplessness on fatigue, it seems as if the tendency is for helplessness to have a more important role in the prediction of pain and functionality than on fatigue.…”

“…This biased interpretation of events has been argued to lead to avoidance of movement and, ultimately, to poor overall physical status [ 17 ]. Initial studies regarding pain catastrophizing were focused solely on its association to pain; however, recent studies have highlighted its relation to other symptoms of fibromyalgia, such as functionality and disability [ 7 , 24 , 25 ]. The specific relationship between pain catastrophizing and fatigue has been scarcely studied in the literature and is not well established in fibromyalgia [ 26 , 27 , 28 , 29 , 30 ].…”