Associations Between Pain Catastrophising and Functional Disability in Adolescents with Chronic Pain: A Test of Indirect Pathways

Abstract

Objective. Functional disability is a devastating consequence of chronic pain. Pain catastrophising (a cognitive process) is often positively associated with functional disability, though the mechanisms underlying this association remain to be elucidated. Few studies have explored whether psychosocial factors play an intermediate role in explaining how pain catastrophising leads to pain-related disability in adolescents with chronic pain. This project investigates whether the relationship between pain catastrophising and functional disability is mediated through anxiety, depression, and self-efficacy in a clinical sample of adolescents with mixed chronic pain conditions. Methods. In a cross-sectional design, 45 adolescents between 10 and 17 years of age (75.6% females) were referred to a tertiary-level chronic pain program and completed a battery of questionnaires assessing their levels of pain catastrophising, self-efficacy, functional disability and symptoms of anxiety and depression. Results. Higher levels of pain catastrophising were found to share strong positive bivariate associations with functional disability, anxiety and depression, and a strong negative association with self-efficacy. In turn, greater symptoms of anxiety and depression were strongly associated with greater functional disability, while lower self-efficacy shared a strong negative association with greater functional disability. Greater levels of pain catastrophising were found to predict greater functional disability, and parallel mediation analysis revealed that lower self-efficacy fully mediated this relationship, but anxiety and depression did not. Conclusion. This novel finding suggests that the critical mechanism by which catastrophising influences disability is through one’s confidence in their ability to perform activities when in pain. Theoretical and clinical implications are discussed. Keywords: Chronic pain, adolescent, self-efficacy, pain catastrophising, functional disability, internalising mental health symptoms.