The Impact of Goal Cognition and Pain Severity on Disability and Depression in Adults with Chronic Pain: An Examination of Direct Effects and Mediated Effects via Pain-Induced Fear

Abstract

A group of 100 adults with chronic low back pain (CLBP), drawn from a larger national sample, completed a questionnaire battery that assessed (among other things) goal conflict and goal self-efficacy, pain severity, pain-induced fear, and 3 months later, two important clinical outcomes: physical disability and depression. Consistent with emerging motivation-centered models of adaptation (e.g., Ford, Humans as selfconstructing living systems: A developmental perspective on behavior and personality. Erlbaum, 1987; Karoly Review of General Psychology, 3, 264-291, 1999) and cognitivebehavioral accounts of pain-specific fears (e.g., Asmundson et al. Clinical Psychology Review, 19, 97-119, 1999), structural equation analyses revealed that (a) goal selfefficacy, goal conflict, and pain severity independently predicted pain-induced fear, (b) pain-induced fear fully mediated the effects of goal conflict and goal self-efficacy on physical disability and depression, and (c) pain-induced fear partially mediated the effects of severity on disability and depression. Results suggest that clinical pain specialists should treat pain-induced fear as a means of forestalling disability and depression, and that they should also seek to modify how CLBP patients think about and organize their life goals.

No pain no gain? Pursuing a competing goal inhibits avoidance behavior

“…Current models of disability [13,44] consider pain-related avoidance as a relatively stable behaviour pattern. The present findings suggest that such view might be too narrow, and that pain behaviour should be considered within a dynamic environment of concomitant, often competing, goals [15,38,46]. Indeed, when patients avoid activities to prevent an increase in pain intensity, this comes often with a cost of the pursuit of personal goals in domains of work, social life, family, recreation, etc… It is likely that in some situations, patients will choose to perform valuable activities despite an (expected) increase in pain.…”

“…Largely neglected, however, is that avoiding pain is often only one goal in a dynamic environment with concomitant, competing goals [15,38,46]. While patients may often attempt avoiding pain by limiting physical activity, other goals related to work, household, or social life rather require persistence of activity.…”

Competing Goals Attenuate Avoidance Behavior in the Context of Pain

“…9,18,29,54 However, the results of the current study show that avoidance can be influenced by the presence of concomitant, competing goals, such as the goal to retrieve a reward, even without changing pain-related fear itself. 23,40,44,47,49 Thus, avoidance behavior may vary from situation-to-situation, also even within individuals.…”

“…9, 29,47,48 Indeed, to avoid bodily harm or pain is often only one goal in a context of other, often competing goals. 6,9,23,25,42,47,51,53,58 In a context of multiple goals, the pursuit of one goal may possibly interfere with the pursuit of other goals. This may give rise to goal conflicts during which the same response elicits opposing outcomes.…”

Interrupted by pain: An anatomy of pain-contingent activity interruptions

“…People in pain may experience a conflict between either interrupting an activity to ease, escape or avoid pain, or continuing the activity and approaching valuable non-pain goals [10,36]. Goal conflicts have a negative impact on 3 affect and well-being [21,27] and may lead to symptom exacerbation [17]. A possible resolution of the conflict is to temporarily suspend non-pain-related activities.…”