# 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.

## Key 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.