Pain Intensity Can Predict Activity Patterns in Chronic Musculoskeletal Pain

The relationship between pain intensity and pain-related avoidance and pacing in older adults with chronic musculoskeletal pain was mediated by pain resilience and catastrophizing. These are the findings of a study published in the Journal of Pain Research.

Researchers from Chengdu Medical College in China recruited adults (N=220) with chronic musculoskeletal pain between 2021 and 2022. Participants responded to a questionnaire that included the Brief Pain Inventory (BPI), Pain Resilience Scale (PRS), Pain Catastrophizing Scale (PCS), and Pain-Related Activity Patterns (POAM-P) instruments. Using these data, the researchers tested 4 hypotheses:

• pain intensity predicts pain-related activity patterns,
• pain resilience mediates pain intensity and pain-related activity patterns,
• pain catastrophizing mediates pain intensity and pain-related activity patterns, and
• pain resilience and catastrophizing together mediate pain intensity and pain-related activity patterns.

The study population comprised patients (mean age, 68 years; 69% women) who had been experiencing chronic musculoskeletal pain for over 10 years (16.8%) and had 3 or more comorbidities (14.5%). The most common chronic musculoskeletal pain locations were lower limbs (66.4%), upper limbs (55.5%), and lower back (25.5%).

In a correlation analysis, pain intensity correlated with:

• pain resilience (r, -0.380; P <.01),
• catastrophizing (r, 0.429; P <.01),
• avoidance (r, 0.495; P <.01),
• overdoing (r, -0.144; P <.05), and
• pacing (r, -0.154; P <.05).

Pain resilience correlated with:

• pain catastrophizing (r, -0.686; P <.01),
• avoidance (r, -0.699; P <.01), and
• pacing (r, 0.207; P <.01).

Pain catastrophizing correlated with:

• avoidance (r, 0.615; P <.01),
• overdoing (r, 0.174; P <.01), and
• pacing (r, -0.372; P <.01).

For pain-related activity patterns, avoidance correlated with overdoing (r, -0.377; P <.01) and pacing (r, 0.153; P <.05), and overdoing correlated with pacing (r, -0.524; P <.01).

In the mediation analyses, pain resilience and catastrophizing were both significant independent mediators of the effects of pain intensity on avoidance, accounting for 33.57% and 8.10% of the variance, respectively. In addition, the pathway from pain intensity to pain resilience to pain catastrophizing to avoidance was also significant, explaining 7.90% of the variance.

For the outcome of pacing, pain intensity was not mediated through pain resilience. However, the pathway from pain intensity to pain resilience to pain catastrophizing to pacing was significant.

These findings may be biased as results relied on self-report.

The researchers concluded, “[O]lder adults with CMP [chronic musculoskeletal pain] often chose the avoidance activity mode. This study demonstrated the relationship between pain intensity and pain-related activity patterns, and the chain mediating effect of pain resilience and pain catastrophizing on pain intensity and pain-related activity patterns. Specifically, pain intensity was positively correlated with activity avoidance and negatively correlated with activity pacing. Pain resilience and pain catastrophizing played an important role in the relationship between pain intensity and activity patterns.”