Abstract
Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. However, previous studies mostly relied on cross-sectional methods, precluding conclusions on the temporal relationship between pain-related social support and disability. Also, research on the behavioral and psychological processes that account for such a relationship is scarce. Therefore, this study aimed at investigating the following longitudinally: (1) direct effects of social support for functional autonomy/dependence on pain-related disability, (2) mediating role of physical functioning, pain-related self-efficacy, and fear, and (3) whether pain duration and pain intensity moderate such mediating processes. A total of 168 older adults (Mage = 78.3; SDage = 8.7) participated in a 3-month prospective design, with 3 moments of measurement, with a 6-week lag between them. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire, and the Tampa Scale for Kinesiophobia. Moderated mediation analyses showed that formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3), that was mediated by self-reported physical functioning (T2) and by pain-related self-efficacy (T2) at short to moderate pain duration and at low to moderate pain intensity, but not at higher levels. Findings emphasized that social support for functional dependence is a risk factor for pain-related disability and uncovered the "why" and "when" of this relationship. Implications for the design of social support interventions aiming at promoting older adults' healthy aging despite chronic pain are drawn.
Highlights
Chronic pain is prevalent and disabling among older adults [49,61,73,78]
Our first aim was to investigate whether perceived promotion of autonomy (T1) would predict a decrease in painrelated disability (T3), and whether perceived promotion of dependence (T1) would predict an increase (T3)
The association between perceived promotion of autonomy and lower pain-related disability has been inconsistently supported [41,42], suggesting that it might be dependent on other factors, such as recipient’s needs [40] or support preferences [5,9,46,47]
Summary
Chronic pain is prevalent and disabling among older adults [49,61,73,78]. Painrelated social support (SS;help that people receive when in pain) has been shown to influence pain-related outcomes, positively [7,31,60] and negatively [17,59,64,66]. Previous studies have shown that formal pain-related SS (from formal caregivers) by promoting functional autonomy (perceived promotion of autonomy) was associated with lower pain-related disability. SS promoting functional dependence (perceived promotion of dependence) has been associated with higher pain-related disability [41,43,42]. The first aim of the present study was to test, longitudinally, whether perceived promotion of autonomy/dependence predicts a decrease/increase in older adults’ pain-related disability (Figure, path). A cross-sectional study concluded that older adults’ selfreported physical functioning partially accounted for the relationship between perceived promotion of autonomy/dependence and lower/higher pain-related disability [42]. Since selfreports of physical functioning might have been influenced by recall biases or social desirability, we aimed at further exploring the mediating role of physical functioning by using self-report and observational measures (Figure1,path2)
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