A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients

Abstract

Objective: The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation). Methods: The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female. Results: Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = −0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R 2 change = 0.177). This association was found to be moderated by frustration tolerance (β = −0.49, t = −2.80, p = 0.006, R 2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41).

Patients With Fibromyalgia Reporting Severe Pain but Low Impact of the Syndrome: Clinical and Pain‐Related Cognitive Features

“…The identification of resilience resources in chronic pain patients is becoming a topic of increasing interest . The present study provides further evidence in this direction by identifying some variables (ie, reduced depressive symptomatology, pain catastrophizing, and psychological inflexibility) differentially characterizing a profile of patients with FM who are especially able to adapt to high levels of pain at a relatively low overall impact of the syndrome.…”

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

“…The preference for the "overall impact" dimension was motivated by the study focus on overall functioning as opposed to functioning in specific situations (e.g., household chorus). Additionally, as indicated in past similar research [48], the inclusion of the "symptom severity" scale would have contaminated the relationship between at least two independent variables (i.e., pain severity and depression) and the dependent variable. As a final remark, it is important to note that all measures were obtained through self-report, which means that perceived functioning might differ from objectively-measured functioning (e.g., with accelerometers or performance-based physical fitness tests) [44,49].…”

Quality of life in chronic pain patients: Illness‐ and wellness‐focused coping as moderators

“…Finally, based on the literature that showed that the reduction in pain intensity was strongly associated with improved physical functioning (Suso-Ribera, Camacho-Guerrero, Osma, Suso-Vergara, & Gallardo-Pujol, 2019;Suso-Ribera, Jornet-Gibert, et al, 2016), the authors expected the following: Hypothesis 3: Coping will moderate the relationship between pain interference and physical and mental QoL; that is, improvements in QoL after a reduction in pain intensity will be facilitated when individuals report more use of wellness-focused coping. Conversely, illness-focused coping will result in an inhibition of the positive effects of pain-reduction efforts on QoL.…”

“…Finally, based on the literature that showed that the reduction in pain intensity was strongly associated with improved physical functioning (Suso‐Ribera, Camacho‐Guerrero, Osma, Suso‐Vergara, & Gallardo‐Pujol, 2019; Suso‐Ribera, Jornet‐Gibert, et al, 2016), the authors expected the following:…”