Catastrophizing, Kinesiophobia, and Acceptance as Mediators of the Relationship Between Perceived Pain Severity, Self-Reported and Performance-Based Physical Function in Women with Fibromyalgia and Obesity

Abstract

Individuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity. Patients and Methods: In this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed. Results: Pain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning. Conclusion: Pain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning.

Biological sex influences psychological aspects of the biopsychosocial model related to chronic pain intensity and interference among South Korean patients with chronic secondary musculoskeletal pain in rheumatic diseases

“…10. 3389/fpsyg.2023.1063164 Frontiers in Psychology 11 frontiersin.org (Esteve et al, 2007;Varallo et 2022). Also, participants were recruited from an center at a hospital which implies the participants were receiving medical care for their diseases.…”

“…This study has several limitations. First, we included multiple measures to build a comprehensive model explaining chronic pain, however, there are still other important factors that we did not include (e.g., anxiety, social support, quality of life, kinesiophobia, pain acceptance, and coping strategies) that have been reported previously ( Esteve et al, 2007 ; Varallo et al, 2022 ). Also, participants were recruited from an outpatient center at a hospital which implies the participants were receiving medical care for their diseases.…”

Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis

“…The previous study of patients with chronic pain has supported the role of the various components of psychological flexibility in their wellbeing and daily functioning (McCracken and Velleman, 2010 ), such as acceptance (Varallo et al, 2021 , 2022 ), defusion, present moment, self-as-content (Nigol and Di Benedetto, 2020 ), committed action, and values (McCracken and Vowles, 2008 ). However, some studies suggest that global psychological flexibility may work better as a predictor of treatment outcome than measures of various components from the psychological flexibility model (Gilpin et al, 2019 ; Åkerblom et al, 2021 ).…”

The role of psychopathological symptoms in lumbar stenosis: A prediction model of disability after lumbar decompression and fusion

“…Persistence of pain after surgery in general (not only spine surgery) showed to be related to several risk factors, like psychological status, fear of movement, executive functions, for example ( Feinmann et al, 1987 ; Ghoneim and O’Hara, 2016 ; Giusti et al, 2020 ). Post-operative pain may in turn worsen disability through fear of movement beliefs and pain catastrophizing mechanisms ( Archer et al, 2011 ; Varallo et al, 2022 ). Depression and anxiety are particularly common in patient with back pain ( Sinikallio et al, 2011 ; Falavigna et al, 2012 ) and they have been hypothesized in previous studies to negatively influence outcome in spine surgery ( Dobran et al, 2018 ).…”