Pain Catastrophizing, Pain Self-Efficacy, and their Interaction as Predictors of Health Outcomes in Chronic Pain
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Introduction
Pain catastrophizing and pain self-efficacy are well-established predictors of health outcomes in chronic pain. Higher pain catastrophizing, a maladaptive cognitive process, predicts worse health outcomes, whereas higher pain self-efficacy, an adaptive cognitive process, predicts better health outcomes. This study examined whether pain catastrophizing and pain self-efficacy interactions predict physical and psychosocial health outcomes at 3 months and their change over 3-months among patients with chronic pain who sought care at a tertiary pain clinic.
Methods
Adults with chronic pain (N = 181; 66.7% female; M age = 58.7) completed baseline assessments of the Pain Catastrophizing Scale (PCS), Chronic Pain Self-Efficacy Scale (CPSS), and PROMIS measures of physical (pain intensity, pain interference, physical function) and psychosocial health (depression, anxiety, anger, loneliness). PROMIS measures were repeated at 3 months. Hierarchical multiple regression analyses tested PCS, CPSS, and their interaction as predictors of outcomes at 3 months and change scores from baseline to 3 months.
Results
The PCS×CPSS interaction significantly improved prediction for physical function (ΔR 2 = 0.02, p = .02). Higher baseline self-efficacy predicted better physical function (β = 0.65, p < .001), but this effect weakened with higher levels of pain catastrophizing. The interaction also predicted change scores in physical function (p = .025) but was marginal after false discovery rate correction (p = .059). Additionally, a significant interaction emerged for loneliness change scores (p = .01): higher self-efficacy predicted greater reductions in loneliness, attenuated by higher catastrophizing.
Conclusion
Pain self-efficacy interacted with pain catastrophizing to predict physical function and loneliness at 3 months. Greater self-efficacy was associated with better outcomes, with associations diminished with higher levels of pain catastrophizing. Findings highlight the moderating role of adaptive and maladaptive cognitions and suggest interventions should address both processes to optimize recovery in physical and social functioning.
Key Message
An interaction between pain catastrophizing and pain self-efficacy predicted physical function and changes in loneliness at 3 months. Greater self-efficacy was associated with better physical function and greater decreases in loneliness, but these associations weakened as catastrophizing increased. These findings highlight how maladaptive and adaptive pain-related cognitions interacted to predict physical and social function in chronic pain.
