Abstract
Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: ‘Pain-avoidance goal’ and ‘Mood-management goal’ (37 and 13% of explained variance, respectively). These factors refer to patients’ preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by task-contingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance.
Highlights
Chronic pain and diseases associated with pain are the most important global causes of disability (Rice et al, 2016)
Regarding validity based on the relation to other constructs, we explored whether high pain catastrophizing would be related to greater endorsement of hedonic goals and whether perfectionism and fear of negative evaluations would be related to greater endorsement of achievement goals (Karsdorp and Vlaeyen, 2011)
This research explored the relationships between goal preferences, affect, activity patterns and health outcomes in fibromyalgia
Summary
Chronic pain and diseases associated with pain are the most important global causes of disability (Rice et al, 2016). Fibromyalgia is a potentially disabling condition characterized by widespread and diffuse musculoskeletal chronic pain not associated with inflammatory or degenerative changes, alongside other physical, affective and cognitive dysfunctions, such as fatigue, non-refreshed sleep, memory problems, decreased attention, and anxiety and depression (Häuser et al, 2015; Arnold et al, 2016) Patients with this chronic pain condition, the cause of which is unknown, usually show high physical and mental comorbidities, such as headaches, irritable bowel syndrome, and rheumatic diseases or stress (Häuser et al, 2015, 2019). The main aim is to increase or maintain the physical, psychological and social functions from a rehabilitation perspective
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