Pain Self-efficacy Mediates the Relationship Between Depressive Symptoms and Pain Severity

Skidmore, Jay R.; Koenig, Alex L.; Dyson, Sara J.; Kupper, Amy E.; Garner, M.J.; Keller, Christopher

doi:10.1097/ajp.0000000000000094

Cited by 40 publications

(43 citation statements)

References 40 publications

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“…Self-efficacy is known to be a major component in dealing with stress and pain, as well as chronic illness. 18,19 In line with recently published studies [50][51][52] the results indicate a potential long term buffering effect of self-efficacy and control beliefs on the development of disability due to LBP, which should be studied further. The influence of the potential buffering factor self-efficacy was not present in the prediction of pain intensity.…”

Section: Self-efficacysupporting

confidence: 83%

<p>Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study</p>

Puschmann¹,

Drießlein²,

Beck³

et al. 2020

JPR

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Purpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain. Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed. Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (±13.4) years; baseline pain intensity: 27.8 (±18.4); disability: 14.3 (±17.9)). In the 1-year follow-up, the stress types "tendency to worry", "social isolation", "work discontent" as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types "tendency to worry", "social isolation", "social conflicts", and "perceived long-term stress" as potential risk factors for both pain intensity and disability. Furthermore, "self-efficacy" ("internality", "self-concept") and "social externality" play a role in reducing pain-related disability. Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.

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Section: Self-efficacysupporting

confidence: 83%

<p>Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study</p>

Puschmann¹,

Drießlein²,

Beck³

et al. 2020

JPR

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“…The review findings support existing theories regarding the factors associated with adaptive psychological functioning despite the enduring nature of pain. In line with existing mediation research whereby the presence of positive psychological constructs facilitate greater coping and adjustment (Skidmore et al 2015;Wright et al 2011), pre and post-intervention changes in self-efficacy (Simm et al 2014) and hope (Howell et al 2015) were associated with significant improvements in psychological well-being. Although increased levels of optimism have also been found to be related to greater adjustment in individuals with chronic pain (Wright et al 2011), only one study (Flink et al 2015) included this variable, with no significant changes in optimism observed following intervention.…”

Section: Discussionsupporting

confidence: 71%

Positive Psychological Interventions and Chronic Non-Cancer Pain: A Systematic Review of the Literature

Iddon

Dickson

Unwin

2016

Int J Appl Posit Psychol

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Chronic pain is a multi-faceted, pervasive condition associated with significant psychosocial impairment. Positive psychological interventions (PPIs) are increasingly delivered in clinical settings, with recent research offering evidence supporting the application of PPIs in predominantly mental-health contexts. To date, no review has considered the impact of PPIs applied in physical-health settings. The aim of this systematic review is to collate the available evidence and identify psychosocial factors that can be improved via PPIs for individuals with chronic non-cancer pain. Particularly, the review focuses upon study outcomes considered to be conceptually-aligned with the aims of such interventions. A systematic search of five electronic databases was conducted utilising terms relating to chronic pain, positive psychological constructs and intervention outcomes. A total of 3289 articles were considered as part of

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“…Residualized change scores represent the difference between the score at follow-up compared with what was predicted at baseline, 49 thereby controlling for baseline score. Residualized change scores are frequently used in studies of mediation15, 43 and are calculated by running a linear regression with the follow-up score as the outcome and the baseline score as the predictor, and saving the residual values (difference between the observed value at follow-up and the value predicted at baseline), which were then used in all subsequent analyses.…”

Section: Methodsmentioning

confidence: 99%

Exploring What Factors Mediate Treatment Effect: Example of the STarT Back Study High-Risk Intervention

Mansell

Hill

Main

et al. 2016

The Journal of Pain

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Interventions developed to improve disability outcomes for low back pain (LBP) often show only small effects. Mediation analysis was used to investigate what led to the effectiveness of the Stratified Targeted Treatment (STarT) Back trial, a large primary care-based trial that treated patients consulting with LBP according to their risk of a poor outcome. The high-risk subgroup, randomized to receive either psychologically-informed physiotherapy (n = 93) or current best care (n = 45), was investigated to explore pain-related distress and pain intensity as potential mediators of the relationship between treatment allocation and change in disability. Structural equation modeling was used to generate latent variables of pain-related distress and pain intensity from measures used to identify patients at high risk (fear-avoidance beliefs, depression, anxiety, and catastrophizing thoughts). Outcome was measured using the Roland–Morris Disability Questionnaire. Change in pain-related distress and pain intensity were found to have a significant mediating effect of .25 (standardized estimate, bootstrapped 95% confidence interval, .09–.39) on the relationship between treatment group allocation and change in disability outcome. This study adds to the evidence base of treatment mediation studies in pain research and the role of distress in influencing disability outcome in those with complex LBP.PerspectiveMediation analysis using structural equation modeling found that change in pain-related distress and pain intensity mediated treatment effect in the STarT Back trial. This type of analysis can be used to gain further insight into how interventions work, and lead to the design of more effective interventions in future.

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Pain Self-efficacy Mediates the Relationship Between Depressive Symptoms and Pain Severity

Abstract: These findings suggest that pain management and rehabilitation programs for CLBP should specifically target PSE as a key aspect of treatment.

Cited by 40 publications

References 40 publications

<p>Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study</p>

<p>Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study</p>

Positive Psychological Interventions and Chronic Non-Cancer Pain: A Systematic Review of the Literature

Exploring What Factors Mediate Treatment Effect: Example of the STarT Back Study High-Risk Intervention

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