Psychological Flexibility And Catastrophizing Predict Pain Interference In Veterans With Chronic Pain: Physical Therapy Considerations

Abstract

The opioid crisis has made imperative the need for effective biopsychosocial interventions for chronic pain. The Empower Veterans Program (EVP) at the Atlanta VA is an interdisciplinary 10-week outpatient program involving group psychoeducation, psychotherapy, and physical therapy for Veterans with chronic pain. The aim is to improve patients’ self-management of pain through increasing coping skills and functioning. Increasing psychological flexibility, the ability to persist or change behavior in pursuit of goals and values, and decreasing pain catastrophizing are two processes that may contribute to the impact of pain, and therefore may influence the efficacy of physical therapy. PURPOSE: To determine whether psychological flexibility and pain catastrophizing predict pain interference in Veterans with chronic pain. METHODS: Baseline measures were assessed in a sample (N=373) of Veterans enrolling in EVP. Stepwise linear regression was used to predict self-reported pain interference (Multidimensional Pain Inventory- Interference/MPI). Model predictors included general and pain-specific measures of psychological flexibility (General = Acceptance and Action Questionnaire/AAQ-II; Specific = Chronic Pain Acceptance Questionnaire/CPAQ), pain catastrophizing (Pain Catastrophizing Scale/PCS), and average pain intensity (Numeric Rating Scale/NRS). Demographic (age, gender and race) and physical performance (Timed Up and Go) were included in the model as covariates. RESULTS: Sample characteristics were age (55.5 ± 0.4), gender (69.2% male), and race (15.9% white/ 79.1% black). The overall adjusted R2 of the model was 0.48 (p = 0.008). Psychological flexibility (CPAQ ß=-.26; AAQ ß =.23), pain catastrophizing (PCS ß =.15), and pain intensity (NRS ß =.24) were significant predictors of pain interference. CONCLUSIONS: Psychological flexibility and pain catastrophizing are two important psychological processes that contribute to pain interference. Rehabilitation strategies should consider the impact and response to treatment related to these constructs, especially aligning exercise and physical activity with values and behavior change principles.