Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia.

Cecilia Peñacoba,Maria Ángeles Pastor-Mira,Sofía López-Roig,Ainara Nardi-Rodríguez,Patricia Catalá,Carlos Suso-Ribera

doi:10.3390/ijerph18105394

Abstract

Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Highlights

A considerable amount of research supports cognitive-behavioral therapy (CBT) as the first line of psychosocial treatment for chronic pain [1]
Given the relevance of pain catastrophizing as a predictor of pain [27,28] and the need to study the effect of activity patterns under models of psychological flexibility [9,10], it seems of interest to analyze the role of the former in the relationship between activity patterns and functionality in chronic pain
The concept of goal, as a variable inherent to psychological flexibility [7,13], has been incorporated [25], showing that preference for pain avoidance goals has been consistently associated with pain and disability through different activity patterns, especially with regards to task-contingent persistence, excessive persistence and activity avoidance patterns

Summary

Introduction

A considerable amount of research supports cognitive-behavioral therapy (CBT) as the first line of psychosocial treatment for chronic pain [1]. The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns

Methods

Results

Discussion

Conclusion