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

Date Published: April 16, 2019

Publisher: Public Library of Science

Author(s): Yusuke Karasawa, Keiko Yamada, Masako Iseki, Masahiro Yamaguchi, Yasuko Murakami, Takao Tamagawa, Fuminobu Kadowaki, Saeko Hamaoka, Tomoko Ishii, Aiko Kawai, Hitoshi Shinohara, Keisuke Yamaguchi, Eiichi Inada, Kazutaka Ikeda.


This study aimed to investigate whether changes in psychosocial factors and pain severity were associated with reduction in disability due to pain among patients with chronic pain. We hypothesized that increased self-efficacy would reduce disability.

This longitudinal observational study included 72 patients. Patients’ psychological and physical variables were assessed before and after 3 months of treatment. Demographic and clinical information were collected, including the Pain Disability Assessment Scale (PDAS), the Pain Self-Efficacy Questionnaire (PSEQ), the Hospital Depression and Anxiety Scale, and the Numeric Rating Scale (NRS) to assess pain intensity. First, univariate regression analyses were conducted to clarify associations between change in PDAS and sex, age, pain duration, changes in psychosocial factors (self-efficacy, anxiety, and depression) and change in pain intensity. Second, multivariate regression was conducted using the variables identified in the univariate analyses (PSEQ and NRS) to detect the most relevant factor for reducing disability.

Univariate regression analyses clarified that changes in PSEQ (β = −0.31; 95% CI: −0.54–−0.08, p = 0.008) and NRS (β = 0.24; 95% confidence interval [CI]: 0.01–0.47, p = 0.04) were associated with reduction in PDAS. Multivariate regression analysis demonstrated that change in PSEQ (β = 0.26; 95% CI: −0.50–−0.02; p = 0.01) was associated with a reduction in disability, independent of change in NRS.

These findings suggest improved self-efficacy is associated with reduced disability in patients with chronic pain, independent of reduction in pain intensity. Focusing on improvement in self-efficacy may be an effective strategy in chronic pain treatment in addition to pain relief.

Partial Text

Chronic pain carries a serious social burden, and is an important global health issue [1] [2] [3]. For many individuals, chronic pain interferes with social life, especially because it negatively impacts activities of daily living (ADL) and health-related quality of life (QOL) [4] [5]. Moreover, chronic pain bears a high economic cost [6].

There are no detailed data regarding the reason why more than half of patients did not visit our clinic again on post-treatment phase. Therefore, we cannot tell how many patients were improved and finished treatment or not improved and stopped treatment.

Our findings provide evidence that higher levels of self-efficacy are highly correlated with greater improvements in pain-related disability. In addition to pain relief, raising self-efficacy may be a primary target in chronic pain treatment.