Background & Aims
CBT for the management of chronic pain centres around addressing modifiable contributors (especially psychological factors/pain-related cognitions and avoidance behaviours) associated with the experience of pain and its impact on the person’s daily functioning, as exemplified by the Fear Avoidance Model of pain [10]. The associations between psychological variables, the experience of pain, and its impact have been well-established in chronic musculoskeletal pain [6; 11]. However, whether psychological factors, such as fear avoidance beliefs, pain catastrophising and pain self-efficacy beliefs, play a moderating role in the relationship between pain intensity and pain-related disability for chronic neuropathic pain (CNP) is yet to be established. This study aimed to test if fear avoidance beliefs, pain catastrophising, and pain self-efficacy beliefs modify the relationship between pain intensity and pain interference for adults with CNP.
Methods
Adults with CNP (N = 58) attending a tertiary pain clinic in Sydney, Australia, were recruited. Patients’ pain conditions were classified as part of the medical and physiotherapy assessments. Only those considered to have definite or probable NP using the Neuropathic Pain Grading System [2] were included. Pain Medicine specialists also used ICD-11 criteria to classify NP [5]. Consented participants completed the measures of fear-avoidance, pain catastrophising, pain self-efficacy, pain intensity and pain interference [1; 3; 4; 7]. Using a cross-sectional design, a linear multiple regression was used to assess the moderating roles of fear avoidance, pain catastrophising, and pain self-efficacy in the relationship between pain and pain interference. Simple slope analysis was used to test the conditional effect of pain intensity on pain interference at low (-1SD), moderate (mean), and high (+1SD) levels of fear avoidance, pain catastrophising, and pain self-efficacy.
Results
Fear-avoidance, pain catastrophising, and pain self-efficacy were found to be significant moderators of the effect of pain intensity on pain interference (fear avoidance: b = -.0211, p = .0142; pain catastrophising: b = -.0286, p = .0075; and pain self-efficacy: b = .0169, p = .0432). But these relationships were nuanced. Simple slope analyses found that pain intensity had a positive and significant association with pain interference for individuals with relatively low to moderate levels of pain catastrophising and fear-avoidance beliefs (all p < .01), but not for those with relatively high scores on those variables. In contrast, pain intensity had a positive and significant association with pain interference for individuals with relatively moderate to high levels of pain self-efficacy (both p < .001), but not for those scoring relatively low on this dimension.
Conclusions
In this cohort of patients with CNP, pain intensity had different associations with pain interference depending on levels of their fear-avoidance, pain catastrophising and pain self-efficacy beliefs, but these relationships were nuanced. When patients were not highly fearful or concerned about their pain, pain intensity was associated with pain interference. However, when patients were highly fearful or concerned about their pain, pain intensity was not associated with pain interference. In contrast, in patients who had low pain self-efficacy, pain intensity was not associated with pain interference. However, in those with moderate to high levels of pain self-efficacy, pain intensity was associated with interference. These findings suggest that interventions for patients with CNP should not just target pain levels, but consider these cognitive variables as well, as has been found with chronic musculoskeletal pain [8; 9].
This study found that in patients with CNP, their pain beliefs play an important, but variable, role in the impact of pain intensity on their level of daily functioning. Measures of pain related-cognitions should be included in routine patient care to develop optimal, targeted interventions for individuals with CNP.
References
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Presenting Author
Mayumi Oguchi
Poster Authors
Mayumi Oguchi
Master of clinical psychology
University of Sydney
Lead Author
Duncan Sanders
The University of Sydney
Lead Author
Paul Wrigley
PhD
The University of Sydney
Lead Author
Daniel Costa
PhD
The University of Sydney
Lead Author
Michael Nicholas
Pain Management Research Institute
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial