Self-Efficacy and Affect as Mediators Between Pain Dimensions and Emotional Symptoms and Functional Limitation in Women With Fibromyalgia

doi:10.1016/j.pmn.2014.04.005

Pain Management Nursing

Volume 16, Issue 1, February 2015, Pages 60-68

https://doi.org/10.1016/j.pmn.2014.04.005 Get rights and content

Abstract

The aim of this study was to investigate the role of self-efficacy and affect as mediators of the relationship between pain and several fibromyalgia (FM) symptoms (functional limitation, depression, and anxiety). We evaluated 144 women with FM for self-reported pain (numerical pain scale), pressure pain sensitivity (pressure pain thresholds), functional limitation (Fibromyalgia Impact Questionnaire), self-efficacy (Chronic Pain Self-Efficacy Scale), depression-anxiety (Hospital Anxiety and Depression Scale), and positive-negative affect (Positive-Negative Affect Scale). Mediating analyses were conducted with ordinary least squares multiple regression analysis. The results demonstrated that self-reported pain and pressure pain sensitivity exhibited significant relationships with functional limitation, anxiety, depression, self-efficacy, and affect. Affect mediated the relationship between pressure pain sensitivity and anxiety, whereas self-efficacy was the mediating variable between self-reported pain and functional limitation and depression. Our results support a complex nature of pain in women presenting with FM, as cognitive and emotional variables have different mediator relationships between pain dimensions and functional and emotional outcomes in women with FM.

Section snippets

Fibromyalgia, Pain, Functional Limitation, Anxiety, and Depression

Fibromyalgia (FM) is a musculoskeletal chronic pain disorder of unknown pathophysiology that mainly affects women. It is characterized by widespread pain, sleep disturbances, fatigue, tenderness, cognitive difficulties, and other somatic complaints. Despite pain being the characteristic symptom in an FM diagnosis, its high rate of comorbidities has resulted in new diagnosis criteria by the American College of Rheumatology (ACR; Wolfe, Clauw, & Fitzcharles, 2010), which introduces the associated

Participants

The study included 144 women with FM with an average age of 50 years (SD = 11). Average reported illness duration (time since diagnosis) was 18 years (SD = 13). Of the women, 81% were married, 12.1% were single, 6% divorced, and the remaining 3% were widowed. Fifty-one percent had primary studies, 21% secondary education, 12% high school education, and the remaining 16% had no studies. Twenty-nine percent were working at the time of the study, 60% were not employed, and the remaining 11% were

Preliminary Analysis: Correlations Among Variables

As shown in Table 1, pressure pain sensitivity levels (PPT) showed negative correlations with anxiety and functional limitation. The NPS showed positive correlations with all the outcome variables (anxiety, depression, and functional limitation). In relation to the mediating factors (affect and self-efficacy), PPT levels exhibited a negative correlation with negative affect and a positive correlation with positive affect. Self-reported pain revealed negative correlations with self-efficacy

Discussion

The scores found for anxiety and depression, pain self-efficacy, and self-reported pain in our sample are similar to those found in other similar Spanish studies about FM (Martín-Aragón et al., 2001, Moioli and Merayo, 2005, Vallejo et al., 2012), although there was a greater variability in functional limitation and affect, thus, supporting the representativeness of the sample regarding symptomatology.

The results of our study show that self-reported pain and pressure pain sensitivity are valid

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Pain Catastrophizing as a Mediator Between Pain Self-Efficacy and Disease Severity in Patients with Fibromyalgia
2023, Pain Management Nursing
Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, sleep disturbances, cognitive impairment, and mood disturbance. Both pain catastrophizing and pain self-efficacy have been found to be mediators of pain treatment effectiveness. However, whether pain catastrophizing mediates the association between pain self-efficacy and FM severity remains unclear.
To examine whether pain catastrophizing mediates the association between pain self-efficacy and disease severity in patients with FM.
This cross-sectional study included the baseline data of 105 people with FM from a randomized controlled trial. Hierarchical linear regression analysis was performed to examine the predictive ability of pain catastrophizing for FM severity. Furthermore, we examined the mediating effect of pain catastrophizing on the association between pain self-efficacy and FM severity.
Pain self-efficacy was negatively associated with pain catastrophizing (β = −.4043, p < .001). FM severity was positively associated with pain catastrophizing (β = .8290, p < .001) and negatively associated with pain self-efficacy (β = −.3486, p = .014). Pain self-efficacy had a direct effect on FM severity (β = −.6837, p < .001) and an indirect effect on FM severity through the effect of pain catastrophizing (β = −.3352, 95% CI bootstrapping −.5008 to −.1858).
Pain catastrophizing independently predicts FM severity and mediates the association between pain self-efficacy and FM severity. Pain catastrophizing should be monitored through interventions aimed at improving pain self-efficacy to reduce symptom burden in patients with FM.
Pain, Racial Discrimination, and Depressive Symptoms among African American Women
2018, Pain Management Nursing
Citation Excerpt :
This work also has important clinical implications. Given the complexity of pain, a holistic pain assessment can be performed that takes into account the role that psychological processes play in pain outcomes (Puente et al., 2015). Health care interventions targeting depressive symptoms in African American women should be holistic and should target coping skills, social management skills, and health promotion (Taylor, Henderson, & Jackson, 1991).
African American women with osteoarthritis (OA) are at high risk of experiencing pain. They report more pain than non-Hispanic White women and men of other racial/ethnic groups. This pain can limit independence and diminish their quality of life. Despite the detrimental effects that pain can have on older African American women with OA, there is a dearth of literature examining factors beyond the OA pathology that are associated with pain outcomes within this population. The purpose of this study was to examine the relationships between racial discrimination and depressive symptoms with pain intensity in African American women with OA. The sample comprised of 120 African American women, aged 50-80 years, with OA, from Texas and New Mexico. The women completed survey booklets to answer study questionnaires. We used multiple linear regression to test associations between racial discrimination, depressive symptoms, and pain intensity. We tested whether depressive symptoms mediated the relationship between racial discrimination and pain intensity by using bootstrapping. Results indicated that racial discrimination was significantly associated with pain intensity and that this relationship was mediated by depressive symptoms, even after controlling for body mass index, years of education, and length of time with OA. Both depressive symptoms and racial discrimination may be modifiable. If these modifiable factors are addressed in this population, there may be decreased pain in middle-aged and older African American women.
The role of self-efficiency toward pain following surgical treatment of carpal tunnel syndrome
2016, Hand Surgery and Rehabilitation
Citation Excerpt :
In chronic low back pain, the extent of the handicap, measured by the “Oswestry Disability Index” (ODI) is inversely proportional to self-efficiency [18]. In fibromyalgia, the functional limitation as measured by the “Fibromyalgia Impact Questionnaire” (FIQ) is inversely proportional to self-efficiency [12]. The functional limitation in knee osteoarthritis as measured by the “Arthritis Impact Measurement Scales” (AIMS) is inversely proportional to self-efficiency [19].
Some very poor results after carpal tunnel syndrome (CTS) surgery are difficult to explain. The main hypothesis of this study was that a relationship exists between self-efficiency toward pain and the difference between pre-operative and post-operative pain. The secondary hypothesis was that a relationship exists between self-efficiency toward pain and the pre-operative and post-operative QuickDASH score.
The records of 64 patients operated for purely subjective CTS were reviewed. The evaluation consisted in determining self-efficacy beliefs from two PSEQ2 questions (1: I can still accomplish most of my goals in life, despite the pain; 2: I can live a normal lifestyle, despite the pain), pain levels and the QuickDASH score.
There was an inversely proportional relationship between the pre-operative PSEQ2 and pain on one hand, and post-operative pain and the pre-operative QuickDASH score on the other hand. We found no correlation between the pre-operative PSEQ2 and post-operative QuickDASH score.
Self-efficiency beliefs as measured by PSEQ2 help to predict pain levels after surgical CTS treatment in the absence of sensory and/or motor deficits and/or associated morbidity.
Certains mauvais résultats après chirurgie du syndrome du canal carpien (SCC) restent inexpliqués. L’hypothèse principale était qu’il existe une corrélation entre l’auto-efficacité face à la douleur et la différence entre la douleur avant et après intervention, et, hypothèse secondaire, entre l’auto-efficacité face à la douleur et la différence entre le score quick DASH avant et après intervention.
Les dossiers de 64 patients opérés d’un SCC idiopathique subjectif pur ont été revus. L’évaluation consistait à mesurer le PSEQ2 à partir de 2 questions (1: je peux encore atteindre la plupart de mes objectifs dans la vie, malgré la douleur; 2: je peux mener une vie normale, malgré la douleur), la douleur et le score quick DASH.
Il existait une relation inversement proportionnelle entre le PSEQ2 préopératoire et la douleur préopératoire d’une part, la douleur postopératoire et le score quick DASH préopératoire d’autre part. On ne trouvait pas de corrélation entre le PSEQ2 préopératoire et le score quick DASH postopératoire.
Au total, l’auto-efficacité mesurée par le PSEQ2 permet de prédire l’intensité de la douleur après traitement chirurgical du SCC en l’absence de signes déficitaires sensitifs et/ou moteurs et/ou de morbidité associée.
Does self-efficacy mediate the relationship between disease impact and depression symptoms among people with fibromyalgia? A longitudinal multilevel mediation model
2024, Current Psychology
How to Generate Self-Efficacy despite Pain: The Role of Catastrophizing and Avoidance in Women with Fibromyalgia
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Understanding the Associations across Fibromyalgia-Related Fatigue, Depression, Anxiety, Self-Esteem Satisfaction with Life and Physical Activity in Portuguese and Brazilian Patients: A Structural Equation Modeling Analysis
2022, Medicina (Lithuania)

View all citing articles on Scopus

: The authors have no competing interests to report.

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Original ArticleSelf-Efficacy and Affect as Mediators Between Pain Dimensions and Emotional Symptoms and Functional Limitation in Women With Fibromyalgia

Abstract

Section snippets

Fibromyalgia, Pain, Functional Limitation, Anxiety, and Depression

Participants

Preliminary Analysis: Correlations Among Variables

Discussion

European Journal of Pain

Pain

Journal of Psychosomatic Research

European Journal of Pain

General Hospital Psychiatry

Pain

European Journal of Pain

European Journal of Pain

Journal of Pain

Pain

Best Practice & Research. Clinical Rheumatology

Revista de Psiquiatría y Salud Mental

Manual Therapy

Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain

Pain

The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations

Journal of Personality and Social Psychology

Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome. A systematic review and meta-analysis of randomized controlled trials

Journal of Rheumatology

Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia

Clinical Journal of Pain

Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health in with chronic pain patients

Disability and Rehabilitation

The fibromyalgia impact Questionnaire: Development and validation

Journal of Rheumatology

Propuesta de una versión de consenso del Fibromyalgia Impact Questionnaire (FIQ) para la población española

Reumatología Clínica

Daily affect relations in fibromyalgia patients reveal positive affective disturbance

Psychosomatic Medicine

Chronic pain associated depression: Antecedent or consequence of chronic pain? a review

Clinical Journal of Pain

Original Article
Self-Efficacy and Affect as Mediators Between Pain Dimensions and Emotional Symptoms and Functional Limitation in Women With Fibromyalgia