Abstract
Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors
of pain-related functional outcomes in youth with chronic pain. Self-efficacy is a
potential resiliency factor that can mitigate the influence that pain-related fear
has on outcomes in youth with chronic pain. Drawing from theoretical assertions tested
among adults with chronic pain, this study aimed to determine whether pain-related
self-efficacy mediates the adverse influence of pain-related fear on functional outcomes
in a sample of youth with chronic headache. In a cross-sectional design of 199 youth
with headache, self-efficacy was strongly associated with fear, disability, school
impairment, and depressive symptoms. Pain intensity and self-efficacy were only modestly
related, indicating that level of pain has less influence on one's confidence functioning
with pain. Self-efficacy partially mediated relationships between pain-related fear
and both functional disability and school functioning but did not mediate the relationship
between pain-related fear and depressive symptoms. These results suggest that confidence
in the ability to function despite pain and fear avoidance each uniquely contributes
to pain-related outcomes in youth with chronic headache. These results further suggest
that treatment for chronic headache in youth must focus not only on decreasing pain-related
fear but also on enhancing a patient's pain-related self-efficacy.
Perspective
Pain-related self-efficacy is an important resiliency factor impacting the influence
of pain-related fear on functional disability and school functioning in youth with
headache. Enhancing self-efficacy may be a key mechanism for improving behavioral
outcomes. Clinicians can reduce pain-related fear and enhance pain-related self-efficacy
through interventions that encourage accomplishment and self-confidence.
Key words
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References
- Prevalence of headache and migraine in children and adolescents: A systematic review of population-based studies.Dev Med Child Neurol. 2010; 52: 1088-1097
- Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.J Counseling Psychol. 1993; 40: 5
- Disability and depression in patients with chronic pain: Pain or pain-related beliefs?.Arch Iran Med. 2008; 11: 263-269
- Self-efficacy: Toward a unifying theory of behavioral change.Psychol Rev. 1977; 84: 191-215
- Self-efficacy. The Exercise of Control.WH Freeman, New York, NY1997
- A 40-year follow-up of school children with migraine.Cephalalgia. 1997; 17 (discussion 487): 488-491
- Fear-avoidance beliefs and catastrophizing: Occurrence and risk factor in back pain and ADL in the general population.Pain. 2002; 99: 485-491
- Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions).Pain. 2006; 125: 35-42
- Pain acceptance-based coping in complex regional pain syndrome Type I: Daily relations with pain intensity, activity, and mood.J Behav Med. 2013; 36: 531-538
- Functional assessment of pediatric pain patients: Psychometric properties of the Functional Disability Inventory.Pain. 2006; 121: 77-84
- Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain.Eur J Pain. 2011; 15: 213-219
- Mindfulness-based cognitive therapy for the treatment of headache pain: A pilot study.Clin J Pain. 2013; 30: 152-161
- Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care.Pain. 2004; 111: 245-252
- Musculoskeletal pain in primary health care: Subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables.J Pain. 2007; 8: 67-74
- Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia.Clin J Pain. 2009; 25: 520-527
- Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement.Arthritis Rheum. 2005; 53: 585-592
- Pain fear avoidance and pain acceptance: A cross-sectional study comparing their influence on adjustment to chronic pain across three samples of patients.Ann Behav Med. 2013; 46: 169-180
- Psychosocial Factors in Pain: Critical Perspectives.Guilford Press, New York, NY1999
- Headaches in childhood and adolescence.Neuropediatrics. 2013; 44: 1-2
- The self-efficiency questionnaire for school situations: Development and psychometric evaluation.Behav Change. 1998; 15: 31-40
- School refusal.in: Fisher J. O'Donohue W. Practitioners' Guide to Evidence-Based Psychotherapy. Kluwer Academic/Plenum Publishers, New York, NY2006
- Relations between pain characteristics, child and parent variables, and school functioning in adolescents with chronic headache: A comparison of tension-type headache and migraine.J Pediatr Psychol. 2013; 38: 351-364
- Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia.Clin J Pain. 2013; 29: 1066-1072
- The Children's Depression Inventory (CDI).Psychopharmacol Bull. 1985; 21: 995-998
- Children's Depression Inventory.Multi-Health Systems, North Tonawanda, NY1992
- Chronic pain acceptance and affective well-being: A coping perspective.Eur J Pain. 2010; 14: 1021-1025
- Pain-related fear in low back pain: A prospective study in the general population.Eur J Pain. 2007; 11: 256-266
- Effectiveness of multidisciplinary intervention in the treatment of migraine: A randomized clinical trial.Headache. 2002; 42: 845-854
- Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis.Psychosoc Med. 2009; 6: Doc01
- Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients.Pain. 2008; 136: 366-372
- Factor structure of the Children's Depression Inventory in a multisite sample of children and adolescents with chronic pain.J Pain. 2013; 14: 689-698
- Measuring pain self-efficacy.Clin J Pain. 2011; 27: 461-470
- The contribution of pain-related anxiety to disability from headache.J Behav Med. 2006; 29: 61-67
- Biofeedback treatment for headache disorders: A comprehensive efficacy review.Appl Psychophysiol Biofeedback. 2008; 33: 125-140
- Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain.Pain. 1992; 48: 339-347
- Pain in children and adolescents: A common experience.Pain. 2000; 87: 51-58
- Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models.Behav Res Methods. 2008; 40: 879-891
- The relationship between psychological factors and disabling musculoskeletal pain in community-dwelling older persons.J Am Geriatr Soc. 2003; 51: 1092-1098
- Predictors of the pain perception and self-efficacy for pain control in patients with fibromyalgia.Spanish J Psychol. 2011; 14: 366-373
- Demographic characteristics, psychosocial measures, and pain in a sample of patients with persistent pain referred to a New Zealand tertiary pain medicine center.Pain Med. 2013; 14: 1101-1107
- The Fear of Pain Questionnaire (FOPQ): Assessment of pain-related fear among children and adolescents with chronic pain.J Pain. 2011; 12: 677-686
- The Fear Avoidance model of chronic pain: Examination for pediatric application.J Pain. 2012; 13: 827-835
- Functional disability in nonspecific low back pain: The role of pain-related fear and problem-solving skills.Int J Behav Med. 2001; 8: 134-148
- The PedsQL 4.0 Generic Core Scales: Sensitivity, responsiveness, and impact on clinical decision-making.J Behav Med. 2002; 25: 175-193
- Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment—A cohort study.BMC Musculoskelet Disord. 2012; 13: 77
- Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain.Behav Res Ther. 2001; 39: 151-166
- The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo.Clin J Pain. 2002; 18: 251-261
- Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.Pain Res Manag. 2002; 7: 144-153
- Fear-avoidance model of chronic musculoskeletal pain: 12 years on.Pain. 2012; 153: 1144-1147
- Numerical rating scale for self-report of pain intensity in children and adolescents: Recent progress and further questions.Eur J Pain. 2009; 13: 1005-1007
- The functional disability inventory: Measuring a neglected dimension of child health status.J Pediatr Psychol. 1991; 16: 39-58
- Application of behavioral therapies in adult and adolescent patients with chronic migraine.Neurol Sci. 2013; 34: S11-S17
- Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients.Eur J Pain. 2007; 11: 711-718
- Adaptation to early knee osteoarthritis: The role of risk, resilience, and disease severity on pain and physical functioning.Ann Behav Med. 2008; 36: 70-80
- Reconsidering Baron and Kenny: Myths and truths about mediation analysis.J Consumer Res. 2010; 37: 197-206
Article info
Publication history
Published online: January 27, 2014
Accepted:
January 16,
2014
Received in revised form:
December 17,
2013
Received:
August 28,
2013
Footnotes
The authors received funding from the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment (to C.B. Berde, MD, PhD), and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital in support of this work. Additional support came from a NIH K23 career development award (HD067202) to LS.
There are no conflicts of interest to report.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
