Can pain self-efficacy mediate the influence of pain intensity on outcomes for patients with musculoskeletal pain? A prospective mediation analysis with 12 months follow-up

TL;DR

This study found that pain self-efficacy slightly mediates the effect of pain intensity on outcomes for musculoskeletal pain patients, but the effect is not clinically significant.

Contribution

The study provides new evidence on the mediating role of pain self-efficacy in musculoskeletal pain outcomes over a 12-month period.

Findings

Pain self-efficacy had a statistically significant but not clinically meaningful mediating effect on health-related quality of life and function.

In patients with low pain self-efficacy, the mediating effect on patient-specific function was more pronounced.

The overall mediating effect of pain self-efficacy on outcomes was not considered clinically important.

Abstract

In longstanding pain, a core treatment aim is to minimize the effect of pain on health-related quality of life and patient-specific function. The study aim was to assess whether the effect of pain intensity on outcome is mediated through pain self-efficacy. A secondary aim was to assess the mediating effect of pain self-efficacy for a subgroup of patients with low pain self-efficacy.

Prospective data of 422 patients with musculoskeletal pain seeking physical therapy was applied in analyses. The exposure was baseline pain intensity and outcomes were health-related quality of life (EQ-5D), patient-specific function (PSFS) and global perceived effect (GPE) at 12 months. The mediator was measured by the 2-item pain self-efficacy questionnaire (PSEQ-2) at baseline and 3 months.

The mediating effect of pain self-efficacy on the relation between pain intensity and health-related quality of life and patient-specific function was statistically, but not clinically, significant: − 0.01 (95% CI − 0.01 to − 0.00) and − 0.08 (95% CI (− 0.15 to − 0.01). For the mediating effect of pain self-efficacy on the relation between pain intensity and global perceived effect, odds ratio was 0.97 (95% CI 0.92 to 1.01). In a subgroup with low baseline pain self-efficacy, the mediating effect of pain self-efficacy was − 0.28 (− 0.55 to − 0.01) for patient-specific function.

Pain self-efficacy did not have an important mediating effect on the relation between pain intensity and outcome. In a subgroup with reduced pain self-efficacy, the effect of baseline pain intensity on patient-specific function was mediated by pain self-efficacy.

ClinicalTrials.gov Identifier: NCT03626389. Registered August 13, 2018 (retrospectively registered).

The online version contains supplementary material available at 10.1007/s11136-025-04118-3.

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