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Associations Between Psychosocial Factors and Pain Intensity, Physical Functioning, and Psychological Functioning in Patients With Chronic Pain: A Cross-cultural Comparison

Ferreira-Valente, Maria A. PhD*,†; Pais-Ribeiro, José L. PhD*,‡; Jensen, Mark P. PhD§

doi: 10.1097/AJP.0000000000000027
Original Articles

Objective: Current models of chronic pain recognize that psychosocial factors influence pain and the effects of pain on daily life. The role of such factors has been widely studied on English-speaking individuals with chronic pain. It is possible that the associations between such factors and adjustment may be influenced by culture. This study sought to evaluate the importance of coping responses, self-efficacy beliefs, and social support to adjust to chronic pain in a sample of Portuguese patients, and discuss the findings with respect to their similarities and differences from findings of studies on English-speaking individuals.

Materials and Methods: Measures of pain intensity and interference, physical and psychological functioning, coping responses, self-efficacy, and satisfaction with social support were administered to a sample of 324 Portuguese patients with chronic musculoskeletal pain. Univariate and multivariate analyses were computed. Findings were interpreted with respect to those from similar studies using English-speaking individuals.

Results: Coping responses and perceived social support were significantly associated with pain interference and both physical and psychological functioning; self-efficacy beliefs were significantly associated with all criterion variables. All coping responses, except for task persistence, were positively associated with pain interference and negatively associated with physical and psychological functioning, with the strongest associations found for catastrophizing, praying/hoping, guarding, resting, asking for assistance, and relaxation.

Discussion: The findings provide support for the importance of the psychosocial factors studied in terms of adjustment to chronic pain in Portuguese patients, and also suggest the possibility of some differences in the role of these factors due to culture.

*Unidade de Investigação em Psicologia e Saúde, Lisboa

Portuguese Foundation for Science and Technology

Faculdade de Psicologia e Ciências da Educação da Universidade do Porto, Porto, Portugal

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

M.A.F.-V. has received PhD grant SFRH/BD/40956/2007 from the Portuguese Foundation for Science and Technology. M.P.J. has received research support, consulting fees, or honoraria in the past 3 years from Allergan, Analgesic Solutions, Bristol-Meyers Squibb, Covidien, Depomed, Endo, Merck, Pfizer, RTI Health solutions, Schwartz Biosciences, Smith & Nephew, ZARS Pharma, Zogenix, US Department of Education, US Department of Veterans Affairs, and the US National Institutes of Health. The remaining authors declare no conflict of interest.

Reprints: Maria A. Ferreira-Valente, PhD, Unidade de Investigação em Psicologia e Saúde, Rua José das Dornas, 107, 3880-791 Ovar, Portugal (e-mail:

Received April 2, 2013

Accepted September 2, 2013

© 2014 by Lippincott Williams & Wilkins