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Pain-related Activity Management Patterns and Function in Patients With Fibromyalgia Syndrome

Racine, Mélanie, PhD*; Galán, Santiago, MSc†,‡,§; de la Vega, Rocío, PhD†,∥; Tomé Pires, Catarina, PhD†,‡,§; Solé, Ester, PhD†,‡,§; Nielson, Warren, R., PhD; Miró, Jordi, PhD†,‡,§,∥,#; Moulin, Dwight, E., MD*; Jensen, Mark, P., PhD

doi: 10.1097/AJP.0000000000000526
Original Articles

Objectives: To clarify the importance of avoidance, pacing, and overdoing pain-related activity management patterns as predictors of adjustment in patients with fibromyalgia syndrome.

Methods: A total of 119 tertiary care patients with fibromyalgia syndrome who agreed to be part of an activity management pain program completed a survey, which requested information about demographics, pain intensity and pain interference, psychological and physical function, and pain-related activity management patterns. Hierarchical regression analyses were used to identify the unique contributions of the 3 different pain-related activity management patterns (avoidance, pacing, and overdoing) to the prediction of pain interference, psychological function, and physical function.

Results: The avoidance pattern was a significant and unique predictor of worse psychological and physical function as well as greater pain interference. Pacing was significantly associated with less pain interference and better psychological function, whereas overdoing was not found to predict patient functioning.

Discussion: The findings confirm the importance of pain-related activity management patterns as predictors of patient function, and support the necessity of addressing these factors in chronic pain treatment. In addition, the results suggest that targeting increases in activity pacing and decreases in pain avoidance, specifically, might yield the best patient outcomes. However, further research to evaluate this possibility is necessary.

*Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University

Department of Psychology, Western University and Lawson Health Research Institute, London, ON, Canada

Unit for the Study and Treatment of Pain—ALGOS

Research Center for Behavior Assessment (CRAMC), Department of Psychology

§Institut d’Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili

#Pediatric Pain Universitat Rovira i Virgili-Fudación Grünenthal, Catalonia, Spain

Department of Rehabilitation Medicine, University of Washington, Seattle, WA

M.R.: salary and travel support for writing this manuscript were funded by The Earl Russell Chair in Pain Research, Western University, London, Ontario, and by a bequest from the estate of Beryl Ivey to W.R.N. Financial support for this project was provided, in part, by grants from Obra Social de Caixabank, Universitat Rovira i Virgili (PFR program), the Spanish Ministry of Economy and Competitiveness (PSI2012-32471, PSI2015-70966-P) awarded to J.M. J.M.: work is supported by the Institució Catalana de Recerca i Estudis Avançats (ICREA-Acadèmia), and Fundación Grünenthal Catalonia, Spain. R.d.l.V.: work is supported by a Beatriu de Pinós Postdoctoral Fellowship (2014 BP-A 00009) granted by the Agency for Administration of University and Research Grants (AGAUR). R.d.l.V.: travel is supported by the R2B grant (grant for the enhancement of knowledge) by the Universitat Rovira i Virgili Catalonia, Spain. The authors declare no conflict of interest.

Reprints: Mélanie Racine, PhD, 1635 rue Mégantic, Saint-Hubert, Montreal, QC, Canada, H4B 2K1 (e-mail:

Received July 25, 2016

Received in revised form April 17, 2017

Accepted May 31, 2017

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