Psychological adjustment to chronic pain : the role of pain catastrophizing, negative copingand psychological inflexibility

Abstract

Introduction: Pain intensity is not the sole determinant of adjustment outcomes in regard to chronic pain. The processes through which pain exerts its influences via psychological variables from different theoretical approaches have been extensively studied. The main objectives of the present study were to study the mediating role of pain catastrophizing, negative coping and psychological inflexibility, as well as their interrelationships, in accounting for depression, anxiety and physical impairment in chronic pain. An integrated model based on cognitive-behavioural and contextual-behavioural theories was proposed. Methods: A cross-sectional study, employing validated self-report questionnaires, was used to investigate pain intensity, pain catastrophizing, negative coping, psychological inflexibility, psychological disturbance and physical impairment in a heterogeneous sample of 340 chronic pain patients recruited from specialty pain clinics. Multiple mediational analyses were carried out by structural equation model. Results: The examined psychological variables significantly and differentially mediated the impact of pain intensity in regard to both psychological and physical dysfunction in a multiple mediation model. From the integrated model proposed, psychological inflexibility demonstrated non-redundant influences over all adjustment outcomes and mediators. Analysis of specific indirect effects revealed that the serial paths from pain to psychological inflexibility to all three adjustment outcomes, were the most influential paths of influences, compared with other indirect paths in the models. In addition, the paths involving pain catastrophizing were relatively more influential for psychological disturbance, while the paths involving negative coping were relatively more influential in relation to physical dysfunction. Psychological inflexibility was shown to relate with pain catastrophizing and negative coping in a theoretically meaningful and coherent way. Conclusions: The relationships between pain, depression, anxiety and physical impairment were significantly mediated by psychological variables in differential manner. The mediation effect via psychological inflexibility was more salient, relative to catastrophizing and negative coping. Theoretical and clinical implications, as well as future research directions, were discussed.