Self-efficacy & pain behavior among subjects with fibromyalgia (FM)

Given the lack of objective physical measures for assessing

fibromyalgia syndrome (FS), the role of pain assessment is

particularly important. The role of psychological factors is

controversial among FS patients. This study was designed to

better understand the relationship between pain behaviors and

psychological variables. Specifically, this study (1) refined

a pain behavior observation (PBO) methodology for use with FS

patients, (2) determined whether stretching is a valid pain

behavior, and (3) assessed whether psychological variables

including self-efficacy and/or depression can predict pain

behaviors after controlling for disease severity and age. The

73 FS subjects meeting the American College of Rheumatology

classification system completed questionnaires measuring

self-efficacy, depression, and pain. Trained physicians

conducted tender-point examinations. Subjects were video-taped

using a standardized procedure. Two trained raters

independently coded all pain behaviors. Kappa coefficients and

correlations among pain behaviors and self-reported pain

indicated that the PBO method was both reliable and valid.

However, the newly defined pain behavior ‘stretching’ was

found to be negatively associated with self-reported pain.

Hierarchical multiple regression (MR) analyses revealed that

depression did not predict pain behavior over and above

myalgic scores and age; however, in 3 separate MR analyses,

self-efficacy for function, pain, and other symptoms each

predicted pain behavior over and above myalgic scores and age.

This study indicated that the original pain behavior scoring

methodology is appropriate for use with the FS population and

should not be modified to include the pain behavior

‘stretching’. Self-efficacy was related to pain behavior while

depression was not among this FS sample.

Buckelew SP, Parker JC, Keefe FJ, Deuser WE, Crews TM, Conway R, Kay

DR, Hewett JE

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