Objectives: In this study we examined the relationships between depressive symptoms, pain severity, and pain self-efficacy (PSE) in patients suffering from chronic low back pain (CLBP). We hypothesized that change in depressive symptoms would significantly influence change in pain severity, and that PSE indirectly affect this relationship.
Methods: Participants were 109 CLBP patients in a four-week multidisciplinary rehabilitation program for CLBP. They completed measures of PSE, depression, and pain severity at admission and discharge. Structural equation modeling was used to test the significance direct and indirect effects from pre-treatment to post-treatment.
Results: Change in depressive symptoms significantly predicted change in pain severity in affective ([beta] =0.358; 95% CI =0.206 to.480, P =0.006), sensory ([beta] =0.384; 95% CI =0.257 to.523, P =0.002), and evaluative pain ([beta] =0.456; 95% CI =0.285 to.605, P =0.002). The indirect effects of change in PSE partially accounted for the relationship between change in depressive symptoms and change in sensory ([beta] =0.105; 95% CI =0.016 to.241, P =0.023) and evaluative pain ([beta] =0.121; 95% CI =0.010 to.249, P =0.040). The relationship between change in depressive symptoms and change in affective pain was fully accounted for by the indirect effect of change in PSE ([beta] =0.203; 95% CI =0.082 to.337, P =0.002).
Discussion: These findings suggest that pain management and rehabilitation programs for CLBP should specifically target PSE as a key aspect of treatment.
(C) 2014 by Lippincott Williams & Wilkins