A Network Analysis of Fear-Avoidance Beliefs, Mood and Disability in Chronic Pain

Although the multifactorial nature of chronic pain-related disability is well established, research has predominantly examined isolated variables or singular pathways that may contribute to this condition. We use a complex systems perspective to examine the interplay of several psychological factors and their unique relationships with chronic pain disability. We analyzed two cross-sectional datasets (N = 935 and 1366) collected at a pain clinic and rehabilitation center in Belgium. These included self-reported data on pain-related fear and avoidance beliefs, depression and anxiety symptoms, and pain intensity and disability. We used Gaussian Graphical Models to examine conditional associations between these variables, their relative importance (having more/stronger relationships), and how they are moderated by pain-related fear and pain intensity. Our analyses revealed highly interrelated networks, with many unique, positive associations between the included factors. Depressive symptoms and pain intensity were most strongly related to disability. Fear-avoidance beliefs featured less prominently than previous studies looking at this concept in isolation suggested. Apart from differences in two associations between samples, and two moderation effects of pain intensity in one sample, the network structure was similar across the two samples. Overall, our results show that psychological factors related to chronic pain and disability have intricate interrelations, highlighting the complexity of chronic pain and the need to study its many components in relation to each other. The consistency across the two samples provides encouraging evidence that the results reflect a stable pattern within this complex system.