Document Type : Research Paper

Authors

1 . Associate Professor, Clinical Psychology, Shahed University

2 MA Student in Clinical Psychology Shahed University

3 Assistant Professor, Psychology, Shahed University

Abstract

Background: There is considerable individual variation in the levels of pain-related disability among people with chronic pain. Pain self-efficacy and fear of movement have been proposed to explain individual differences in the level of pain-related disability.
Objective: This study aims to investigate whether pain self-efficacy and fear of movement mediate the relationship between pain intensity and disability in patients with chronic pain.
Method: In a cross-sectional design, 195 chronic pain patients completed measures for pain intensity, disability, pain self-efficacy and fear of movement.
Results: The mean age (SD) of the sample was 45.6 years (12) and 73% of the sample reported their main pain sites as low back and legs. Regression analyses were used to test the mediational hypothesis. The first regression analysis indicated that pain self-efficacy beliefs partially mediated the effects of pain intensity on disability. The results of the Sobel test confirmed this mediational effect (Z = 3.40, p < 0.001). The second regression analysis indicated that fear of movement partially mediated the effect of pain intensity on disability. The results of the Sobel test confirmed this mediational effect (Z = 4.43, p< 0.001).
Conclusion: Pain self-efficacy and fear of movement are important in terms of understanding the relationship between pain and disability. The clinical implications of these findings are discussed in the paper.

Keywords

منابع فارسی
اصغری، محمدعلی؛ کرمی، باقر؛ رضایی، صدریه. (1381). «میزان شیوع درد عمرانه و درد مزمن در دو شهر ایلام و قروه»، مجله روان‌شناسی، شماره ۶، صص ۳۰-۵۰.
اصغری، محمدعلی. (1383). میزان‌های شیوع درد مزمن مستمر و عود کننده در میان کارکنان یک واحد صنعتی بزرگ در تهران و بررسی تاثیر درد بر زندگی روزانه و فعالیت اجتماعی آنها. دانشور رفتار، جلد ۴، صص ۱-۱۴.
اصغری، محمدعلی؛ گلک، ناصر. (1387). بررسی اعتبار و پایایی پرسشنامه چند وجهی درد در جمعیت ایرانی مبتلا به درد مزمن. مجله روان‌شناسی، صص 72-50.
رحمتی، نرگس (1389). بررسی ویژگی‌های روان سنجی مقیاس فاجعه آفرینی درد و مقیاس ترس از حرکت در بیماران درد مزمن، پایان نامه کارشناسی ارشد. تهران: دانشگاه شاهد.
 
منابعانگلیسی
Altmaier EM, Russel DW, Kao CF, Lehmann TR, Weinstein JN. (1993). Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. Journal of Counselling Psychology;40:335-339.
Anderson KO, Dowds BN, Pelletz RE, Edwards WT. (1995). Peeters-Asdourian C. Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain. Pain;63:77-84.
Arnstein P, Caudill M, Mandle C, Norris A, Beasley R. (1999). Self-efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain;80:483-491.
Asghari A, Nicholas MK. (2001). Pain self-efficacy beliefs and pain behaviour: A prospective study. Pain;94:85-100.
Asghari A, Nicholas M. (2009). An Investigation of Pain Self-Efficacy Beliefs in Iranian Chronic Pain Patients: A Preliminary Validation of a Translated English-Language Scale. Pain; 10:619-632.
Asghari A. (2011). Psychometric properties of a modified version of the Roland-Morris disability questionnaire (M-RMDQ). Archives of Iranian Medicine; 14: 327-331.
Bandura A. (1977). Self-efficacy: toward a unifying theory of behavioural change. Psychological Review;84:191‑215.
Baron, R. M, & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
Bates MS, Edwards WT, Anderson KO. (1993). Ethno cultural influences on variation in chronic pain perception. Pain;52:101-12.
Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamso M, Cousins MJ. (2001). Chronic pain in Australia: a prevalence study. Pain;89:127-134.
Blyth FM, March LM, Nicholas MK, Cousins MJ. (2003). Chronic pain, work performance and litigation. Pain, 103: 41-47.
Cano, A., Mayo, A., Ventimiglia M. (2006). Coping, pain severity, interference and disability: the potential mediating and moderating roles of race and education. Journal of Pain,7:459-468.
Costa, LdCM, Maher C, McAuley JH, Hancock, MJ, Smeets RJEM. (2011). Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. European Journal of Pain,;15:213-219.
Crombie IK, Oakley Davies HT. (1999). Requirements for epidemiological studies. In: Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff M (Eds). Epidemiology of Pain. Seattle: IASP Press. 17-24
Edwards RR, Fillingim RB. (1999). Ethnic differences in thermal pain responses. Psychosomatic Medicine; 61:346-354.
 Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. (2010). Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain, 148: 398-406.
Gheldof ELM, Vinck J, Van den Bussche E, Vlaeyen JWS, Hidding A, Crombez G. (2006). Pain and pain-related fear are associated with functional and social disability in an occupational setting: evidence of mediation by pain-related fear. European Journal of Pain;10:513–25.
Gheldof, ELM, Crombez G,  Van den Bussche E, Vinck J, Van Nieuwenhuyse A, Moens G, Mairiaux P, Vlaeyen JWS. (2010). Pain-related fear predicts disability, but not pain severity: A path analytic approach of the fear-avoidance model. European Journal of Pain, 14: 871-879.
Hobara M. (2005). Beliefs about appropriate pain behaviour: Cross-cultural and sex differences between Japanese and Euro-Americans. European Journal of Pain; 9:389-393.
Jensen MP, Turner JA, Romano JM.  (1991). Self-efficacy and outcome expectancy relationship to chronic pain, coping strategies and adjustment. Pain;44:263-269.
Jordan, M.S., Lumley, M.A., Leisen, J.C. (1998). The relationships of cognitive coping and pain control beliefs to pain and adjustment among African–American and Caucasian women with rheumatoid arthritis. Arthritis Care Research,11:80–88.
Keefe FJ, Lefebvre JC, Maixner W, Salley AN, Caldwell DS. (1997). Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. Arthritis Care Research;10:177–84. 
Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. (2004). Psychological aspects of persistent pain: current state of the science. Journal of Pain;5:195-211.
Kerns RD, Haythornthwaite JA. (1988). Depression among chronic pain patients: cognitive-behavioural analysis and effect on rehabilitation outcome. Journal of Consulting and Clinical Psychology; 56:870-6.
Lethem J, Slade PD, Troup JD, Bentley G. (1983). Outline of a fear-avoidance model of exaggerated pain perception-I. Behaviour Research and Therapy; 21:401–8.
Linton, S. J. (2000). A review of psychological risk factors in back and neck pain. Spine, 25, 1148–1156.
MacKinnon DP, Krull JL, Lockwood CM. (2000). Equivalence of the mediation, confounding and suppression effect. Prevention Science; 1:173–81.
Magnusson JE, Fennell JA. (2005). Understanding the role of culture in pain: Assessing pain from a Maori perspective, 11th World Congress of Pain, Sydney.
Main CJ, Sullivan MJL,Watson PJ. (2008). Pain Management: Practical applications of the biosychosocial perspective in clinical and occupational setting. 2nd Edition. Churchill Livingstone: Elsevier.
Nayak S, Shiflett SC, Eshun S, Levine FM. (2000). Culture and gender effects in pain beliefs and the prediction of pain tolerance, Cross Cultural Research; 34:135-151.
Nicholas MK, Wilson PH, Goyen J. (1992). Comparison of cognitive-behavioural group treatment and an alternative non‑psychological treatment for chronic low back pain. Pain; 48:339‑347.
Nicholas MK. (1989). Self-efficacy and chronic pain. Paper presented at the annual conference of the British Psychological Society, St. Andrews, Scotland.
 Nicholas MK. (2007). The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain; 11:153-163.
Nicholas MK, Asghari A, Corbett M, Smeets RJEM, Wood BM, Overton S, Perry C, Tonkin LE, Beeston L. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? European Journal of Pain. In Press
Nunnally JC, Bernstein IH. (1994). Psychometric Theory, 3rd edn. New York: McGraw-Hill.
Otis JD, Cardella LA, Kerns RD. (2004). The influence of family and culture on pain. In: Dworkin RH, Breitbart WS, eds. Psychological aspects of pain: A handbook for health care providers, Progress on pain research and management, Vol.27. Seattle: ISAP Press, (pp. 29-45).
Pincus T, Morley S. (2002). Cognitive appraisal. In: Linton SJ, (ed,). New Avenues for the Prevention of Chronic Musculoskeletal Pain and Disability. Pain Research and Clinical Management, Vol 12. BV: Elsevier Science, (pp.123-142).
Roland M, Morris S. (1983). A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine; 8:141-4.
 Rudy TE, Lieber SJ, Boston JR, Gourley LM, (2003). Baysal E. Psychosocial predictors of physical performance in disabled individuals with chronic pain. Clinical Journal of Pain; 19:18-30.
Sheffield D, Biles PL, Orom H, Maixner W, Sheps DS. (2000). Race and sex differences in cutaneous pain perception. Psychosomatic Research Medicine; 62:517-523.
Sullivan MJL. , Bishop S. & Pivik J.(1995). The Pain Catastrophizing scale: development and validation. Psychological Assessment; 7: 524–32.
Sullivan M.J.L. , Thorn B., Jennifer A. , ، Keefe F. , Martin M.,  Laurence A. Bradley, & Lefebvre J.C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Pain 17: 52–64.
Taylor WJ, Dean SG, Siegert RJ. (2006). Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskeletal pain in a cross-sectional general adult population survey. Pain; 125:225-232.
Turk DC, Meichenbaum D, Genest M. (1983). Pain and Behavioural Medicine. A Cognitive-Behavioural Perspective. New York: Guilford Press.
Turk DC. (2002b). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain; 18:355-65.
Turner JA, Ersek M, Kemp C. (2005). Self-Efficacy for Managing Pain Is Associated With Disability, Depression, and Pain Coping Among Retirement Community Residents With Chronic Pain, J Pain; 6:471-479.
Vlaeyen J.W. , Kole-Snijders A.M. , Boeren R.G. & van Eek H. (1995). Fear of movement/ (re)injury in chronic low back pain and its relation to behavioural performance. Pain. 62: 363–372.
Vlaeyen JW, Morley S, Vlaeyen JWS, Morley S. (2005). Cognitive-behavioral treatments for chronic pain: what works for whom? Clinical Journal of Pain; 21:1–8.
Vlaeyen JWS, Linton SJ. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain; 85:317–32.
Westman A; Linton SJ, hrvik JO, Wahle´n P, Leppert J. (2008). Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain? A validation of the O¨rebro Musculoskeletal Pain Screening Questionnaire. European Journal of pain, 12: 641-649.
Woby SR, Roach NKUrmston MWatson PJ. (2005). Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain, 117:137-44