Domain Specific Self-Efficacy Mediates the Impact of Pain Catastrophizing on Pain and Disability in Overweight and Obese Osteoarthritis Patients

Abstract

This study examined whether self-efficacy mediated the relationship between pain catastrophizing and pain and disability. Participants were 192 individuals diagnosed with osteoarthritis (OA) of the knees who were overweight or obese. Multiple mediator analyses were conducted to simultaneously test self-efficacy for pain control, physical function, and emotional symptoms as mediators while controlling for demographic and medical status variables. Higher pain catastrophizing was associated with lower self-efficacy in all three domains (ps< .05). Self-efficacy for pain control fully mediated the relationship between pain catastrophizing and pain (β=.08, Sobel test Z=1.97, p<.05). The relationship between pain catastrophizing and physical disability was fully mediated by self-efficacy for physical function (β=.06, Sobel test Z=1.95, p=.05). Self-efficacy for emotional symptoms partially mediated the relationship between pain catastrophizing and psychological disability (β=.12, Sobel test Z=2.92, p<.05). These results indicate that higher pain catastrophizing contributed to greater pain and disability via lower domain-specific self-efficacy. Efforts to reduce pain and improve functioning in OA patients should consider addressing pain catastrophizing and domain specific self-efficacy. Pain catastrophizing may be addressed through cognitive therapy techniques and self-efficacy may be enhanced through practice of relevant skills and personal accomplishments. Perspective This paper found that higher pain catastrophizing contributed to great pain and disability via domain specific self-efficacy. These results suggest that treatment efforts to reduce pain and improve functioning in OA patients who are overweight or obese should consider addressing both pain catastrophizing and self-efficacy.

Musculoskeletal Pain, Fear Avoidance Behaviors, and Functional Decline in Obesity

“…55 High arthritis self-efficacy also lessens pain catastrophizing in obese persons with knee OA and increases physical activity. 55,56 Avoidance of physical activity leads to additional weight gain and development of distorted or irrational thoughts or highly negative thinking. 56 Treatment efforts include a restructuring of cognitive patterns and a modification of negative to positive thoughts.…”

“…55,56 Avoidance of physical activity leads to additional weight gain and development of distorted or irrational thoughts or highly negative thinking. 56 Treatment efforts include a restructuring of cognitive patterns and a modification of negative to positive thoughts. A recent randomized controlled trial examining psychological disability in obese OA patients found that the combination of pain-coping-skills training and behavioral weight management resulted in significant reduction in negative psychological conditions including pain catastrophizing.…”

Depression and Perceived Quality of Sleep in Older Adults with Knee Osteoarthritis

“…The interrelations between BMI, depressed mood and activity limitations may be explained by low self-efficacy (i.e. low confidence in the ability to complete a task or activity) [38,39]. In both overweight and depressed people low self-efficacy may lead to avoidance of activities [40,41] and thereby activity limitations [42].…”

Are Psychological Factors Associated with Pain Worsening in Individuals with Knee Osteoarthritis? A Systematic Review

“…Of eleven studies [14][15][16][17][18][19][20][21][22][23][24], six at least showed a significant relationship between depression and pain, but these findings corresponded to evidence level IV because they were confirmed by cross-sectional studies; the results of the two cohort studies were not consistent. Pain catastrophizing had been measured by ten studies [14,15,19,20,23,[25][26][27][28][29] in our review and was shown to be related with pain worsening in six cross-sectional studies as evidence level IV and in one prospective cohort study as evidence level II. Self-efficacy was significantly related to pain worsening in four studies [16,25,27,30], and one study suggesting this finding …”

“…Pain catastrophizing had been measured by ten studies [14,15,19,20,23,[25][26][27][28][29] in our review and was shown to be related with pain worsening in six cross-sectional studies as evidence level IV and in one prospective cohort study as evidence level II. Self-efficacy was significantly related to pain worsening in four studies [16,25,27,30], and one study suggesting this finding …”