Self-Regulatory Processes, Motivation to Conserve Resources and Activity Levels in People With Chronic Pain: A Series of Digital N-of-1 Observational Studies.

Gail Mcmillan,Diane Dixon

doi:10.3389/fpsyg.2020.516485

Abstract

ObjectivesMotivational and self-regulatory processes during goal pursuit may account for activity patterns in people with chronic pain. This article describes a series of N-of-1 observational studies designed to investigate the influence of goal-related factors on fluctuations in motivation to conserve resources and objectively measured activity levels.MethodsFour participants with chronic pain who attended a formal pain management program (PMP; 41–59 years old; three female) were recruited and completed digital daily diaries for 11–12 weeks. The daily dairies, delivered via text message, measured self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, pain, and motivation to conserve resources. Continuously worn accelerometers measured physical activity and sedentary time. Analyses were conducted individually for each participant. The effects of self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, and pain on motivation to conserve resources, physical activity and sedentary time were assessed with dynamic regression modeling.ResultsDifferent patterns of associations between the predictors and outcomes were observed across participants. Most associations occurred concurrently (e.g., on the same day). Perceived demand was the only variable to predict motivation to conserve resources, physical activity, and sedentary time. Motivation to conserve resources and sedentary time were most frequently predicted by goal striving and perceived demand. Self-regulatory fatigue and pain intensity both predicted motivation to conserve resources in two participants and sedentary time in one participant. Motivation to conserve resources predicted sedentary time in two participants.ConclusionThis study was the first to examine the impact of fluctuations in self-regulatory processes on motivation to conserve resources and objective activity levels within individuals with chronic pain. The results generally supported recent affective-motivational views of goal pursuit in chronic pain. This study demonstrated that N-of-1 observational studies can be conducted with patients during a PMP using digital technologies. The use of these approaches may facilitate the application of personalized medicine.

Highlights

Both underactivity and overactivity patterns have previously been deemed maladaptive and implicated in the maintenance and exacerbation of chronic pain (Philips, 1987; Vlaeyen and Linton, 2000, 2012; Hasenbring and Verbunt, 2010; Hasenbring et al, 2012)
A series of N-of-1 observational studies were conducted for approximately 84 days (12 weeks) over the duration of a Pain Management Program (PMP)
Questionnaire scores for fear of movement, anxiety and depression for participant three are missing as this was not recorded at the first PMP session

Summary

Introduction

Both underactivity and overactivity patterns have previously been deemed maladaptive and implicated in the maintenance and exacerbation of chronic pain (Philips, 1987; Vlaeyen and Linton, 2000, 2012; Hasenbring and Verbunt, 2010; Hasenbring et al, 2012). Overactivity, known as persistence or endurance behavior, can increase pain and lead to long, inactive recovery periods or a “yo-yo” pattern of activity (Fordyce, 1976; Nielson et al, 2013). The utility of describing underactivity or overactivity as maladaptive has been challenged. It seems that only a small subset of people with chronic pain reduce activity levels (Bousema et al, 2007; Pincus et al, 2010; van Weering et al, 2011). There is still ambiguity as to when endurance behavior can be detrimental or advantageous (Kindermans et al, 2011; Andrews et al, 2012; Hasenbring et al, 2012)

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