Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients

Abstract

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15–27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: ‘Fatigue-avoidance goal’ and ‘Mood-management goal’ (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Exploring the Preference for Fatigue-avoidance Goals as a Mediator Between Pain Catastrophizing, Functional Impairment, and Walking Behavior in Women With Fibromyalgia

“…Pain catastrophizing was only significantly associated with preference for fatigue-avoidance goals. Our results reveal that preference for fatigue-avoidance goals correlated significantly with functional impairment and less distance walked in the 6MWT, which supports the results found by Peñacoba et al 26 These results reinforce the mediation that was hypothesized in this study based on previous research linking catastrophizing with functional impairment and activity avoidance. 16 As in a previous study, 26 the present results also support the fear-avoidance models 17,53,54 applied to fatigue.…”

“…Pain catastrophizing and preference for fatigue-avoidance goals were positively associated with activity avoidance, and activity avoidance was associated with an increase in fatigue, pain and FM impact. 26 Consistent with previous research, the highly disabling impact of FM produces activity and physical exercise reduction. Nevertheless, physical exercise is a non-pharmacological therapeutic recommendation.…”

“…Preference for fatigue-avoidance goals was assessed using the fatigue-avoidance goal subscale of the Spanish version of the GPQ for Fatigue (GPQ-F). 26 It includes 6 items in a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree), where higher scores indicate stronger preferences for a fatigue-avoidance goal relative to an achievement goal. The total score of the subscale is the mean of the 6 items.…”

“…This relationship was mediated by activity avoidance. 25 Following models proposed by Karsdorp and Vlaeyen 31 and Pastor-Mira et al, 25 Penacoba et al 26 assessed fatigue in the context of goal-based motivational theories in women with FM. Two different factors were found: preference for fatigue-avoidance goals and preference for moodmanagement goals.…”

“…Thus, the aim of this study was to analyze the role of preference for fatigue-avoidance goals in the known association between pain catastrophizing, walking behavior and functional impairment, according to the Goal Pursuit Questionnaire (GPQ) for fatigue model proposed by Peñacoba et al 26 We hypothesize that catastrophic cognitions about pain will predict preference for fatigue-avoidance goals and that this preference will predict more problems in functioning and less distance walked in a laboratory setting. In addition, functional impairment would affect the distance walked.…”