The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache

J Pain. 2014 May;15(5):527-34. doi: 10.1016/j.jpain.2014.01.493. Epub 2014 Jan 23.

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.

Keywords: Pain-related self-efficacy; headache; mediation analysis; pain-related fear; youth.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achievement
  • Adolescent
  • Child
  • Chronic Disease
  • Cross-Sectional Studies
  • Depression / psychology
  • Fear*
  • Female
  • Headache Disorders / physiopathology*
  • Headache Disorders / psychology*
  • Humans
  • Male
  • Models, Psychological
  • Pain / psychology*
  • Pain Measurement
  • Psychiatric Status Rating Scales
  • Schools
  • Self Efficacy*
  • Severity of Illness Index