Association between change in self-efficacy and reduction in disability among patients with chronic pain

Key points

1. 01Improvement in self-efficacy (confidence to perform activities despite pain) was associated with reduced disability, independent of how much pain intensity changed.
2. 02Reduction in pain intensity was linked to less disability on its own, but this link disappeared once self-efficacy was accounted for.
3. 03Changes in anxiety and depression were not significantly associated with changes in disability in this group.
4. 04All measures (disability, self-efficacy, anxiety, depression, pain intensity) improved significantly over the 3-month treatment period.
5. 05Because the study was observational with no controlled or self-efficacy-targeted treatment, it cannot prove that raising self-efficacy causes lower disability.

How it was conducted

Design

Single-center longitudinal observational study, pre- and post-treatment over 3 months

Participants

72 outpatients with chronic pain (33 men, 39 women), mean age 65.2 years, from a Japanese pain clinic

Treatment

Not controlled or standardized; physicians chose individualized therapy per Japanese chronic pain guidelines (pharmacotherapy, interventional, psychological, rehabilitation)

Measures

Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEQ), Hospital Anxiety and Depression Scale (HADS), Numeric Rating Scale (NRS)

Primary outcome

Change in pain-related disability (PDAS) and its associations with changes in self-efficacy, anxiety, depression, and pain intensity

Analysis

Univariate and then multivariate linear regression, adjusting for age, sex, and pain duration; significance at p<0.05

What they found

• Univariate regression: change in PSEQ (self-efficacy) was associated with change in disability, beta = -0.31 (95% CI: -0.54 to -0.08), p = 0.008.
• Univariate regression: change in NRS (pain intensity) was associated with change in disability, beta = 0.24 (95% CI: 0.01 to 0.47), p = 0.04.
• Changes in HADS anxiety (beta = 0.20, 95% CI: -0.03 to 0.43, p = 0.09) and HADS depression (beta = 0.18, 95% CI: -0.06 to 0.41, p = 0.14) were not significantly associated with change in disability.
• Multivariate regression: change in PSEQ remained associated with reduced disability, beta = -0.26 (95% CI: -0.50 to 0.02), p = 0.01 (R2 change = 0.12, F change = 4.5).
• Multivariate regression: change in NRS was no longer associated with disability after accounting for self-efficacy, beta = 0.15 (95% CI: -0.09 to 0.39).
• All measures improved significantly from pre- to post-treatment: PDAS 23.68 to 19.81 (p<0.01), PSEQ 32.00 to 36.60 (p<0.01), HADS anxiety 6.36 to 4.78 (p<0.01), HADS depression 6.74 to 5.54 (p=0.02), NRS 5.56 to 4.26 (p<0.01).

Limitations

• Single-center study with only 72 patients, limiting generalizability and statistical power; patients could not be stratified by pain diagnosis.
• Observational design with no controlled or self-efficacy-targeted treatment, so causation cannot be established and self-efficacy may have improved independent of therapy.
• More than half of identified patients did not return at 3 months and were excluded, introducing likely selection bias toward patients satisfied with treatment.
• Short 3-month follow-up examining relatively few factors; baseline anxiety and depression were below screening cut-offs, which may explain their lack of association.

Why it matters

For patients

Working with your care team to build confidence in doing daily activities despite pain may help you function better, even if the pain does not fully disappear.

For clinicians

Consider measuring and targeting pain self-efficacy (for example with the PSEQ) alongside pain control, as improvement in self-efficacy was linked to reduced disability independent of pain intensity in this cohort.

For readers

This early, small observational study supports a known idea that self-efficacy matters in chronic pain, but it is hypothesis-generating rather than confirmatory and needs larger controlled trials.