The Mediating role of Pain Catastrophe, Depression and Anxiety in the Relationship between Psychological Flexibility and Pain Self-Efficacy in Patients with Musculoskeletal Pain

Abstract

Background: Musculoskeletal pain is one of the most common pains in patients referred to medical centers which may have a psychological basis. The aim of this study was to develop a structural model to explain the mediating role of catastrophizing pain, depression and anxiety between psychological flexibility and pain self-efficacy in patients with musculoskeletal pain. Methods: In a cross-sectional study, 200 patients with chronic musculoskeletal pain were selected by convenience sampling method from those referred to medical centers affiliated to Isfahan University of Medical Sciences in 2020-2021. Eligible participants filled out: Chronic Pain Acceptance Questionnaire (CPAQ), Cognitive Fusion Questionnaire (CFQ), Self-Experience Questionnaire (SEQ), Value-based Life Questionnaire (VLQ), Committed Action Questionnaire (CAQ-8), Pain Self-Efficacy Questionnaire (PSEQ) and the Mindful Attention Awareness Scale (MAAS), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Then the data were analyzed using SPSS-24 and AMOS software and statistical methods of regression analysis and structural equations. Findings: The results showed that the direct effect coefficient of pain catastrophizing, anxiety, depression and psychological flexibility on pain self-efficacy is (0.357), (0.255), (0.127) and (0.849) respectively. The total relationship between psychological flexibility and pain self-efficacy is (0.346). To test the suitability of the models, NFI, TLI, CFI and IFI indices were used, which were within acceptable limits. Conclusion: The psychological flexibility variable predicts pain self-efficacy mediated by catastrophic pain, depression and anxiety (P < 0.01, r = 0.85) and it appears that predicting pain catastrophe, depression, anxiety and psychological resilience can increase pain self-efficacy. Ultimately, the improvement of these psychological factors may affect the process of better disease management. © 2022 Isfahan University of Medical Sciences(IUMS). All rights reserved.