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If you read nothing else
Bottom line
Improved self-efficacy was associated with reduced pain-related disability independent of pain intensity, but this small, single-center observational study shows association rather than proof that any specific treatment causes the benefit.
Preliminary evidencePublished
Evidence hierarchy
Study participants
Japanese pain-clinic outpatients aged 20+ with various chronic pain conditions persisting at least 3 months
Study Summary
This single-center longitudinal observational study of 72 Japanese outpatients with various types of chronic pain examined whether changes in psychosocial factors and pain intensity over 3 months of usual care were associated with reductions in pain-related disability. After treatment, all measures improved significantly. Regression analyses found that an increase in pain self-efficacy (PSEQ) was associated with reduced disability (PDAS) independent of any reduction in pain intensity (NRS), while changes in anxiety and depression (HADS) were not associated with disability change. The authors suggest that improving self-efficacy may be a useful target in chronic pain treatment alongside pain relief, while noting the study was observational and cannot establish that any specific therapy caused the change.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Increased self-efficacy was associated with reduced disability, independent of pain intensity | In multivariate regression, change in PSEQ (self-efficacy) was associated with reduction in PDAS (disability) (β = 0.26; 95% CI: -0.50 to -0.02; p = 0.01), independent of change in pain intensity (NRS). R-squared change = 0.12, F change = 4.5. | High |
| Anxiety and depression changes were not associated with disability change | Changes in HADS-Anxiety and HADS-Depression were not significantly associated with change in PDAS. The authors note participants' mean anxiety and depression scores were below the recommended screening cut-offs, which may explain the lack of association. | Medium |
| Pain intensity reduction alone did not retain an independent association with disability | Although change in NRS was associated with change in PDAS in univariate analysis (β = 0.24; 95% CI: 0.01 to 0.47, p = 0.04), it was no longer associated with disability in the multivariate model once self-efficacy was included. | Medium |
| All outcome measures improved over 3 months of usual care | PDAS, PSEQ, HADS, and NRS all improved significantly at the post-treatment (3-month) evaluation. Treatment was not standardized; physicians selected individualized therapy based on Japanese clinical guidelines for chronic pain. | Low |
In multivariate regression, change in PSEQ (self-efficacy) was associated with reduction in PDAS (disability) (β = 0.26; 95% CI: -0.50 to -0.02; p = 0.01), independent of change in pain intensity (NRS). R-squared change = 0.12, F change = 4.5.
Changes in HADS-Anxiety and HADS-Depression were not significantly associated with change in PDAS. The authors note participants' mean anxiety and depression scores were below the recommended screening cut-offs, which may explain the lack of association.
Although change in NRS was associated with change in PDAS in univariate analysis (β = 0.24; 95% CI: 0.01 to 0.47, p = 0.04), it was no longer associated with disability in the multivariate model once self-efficacy was included.
PDAS, PSEQ, HADS, and NRS all improved significantly at the post-treatment (3-month) evaluation. Treatment was not standardized; physicians selected individualized therapy based on Japanese clinical guidelines for chronic pain.
Strengths
- Longitudinal design with pre- and post-treatment measurement over 3 months, allowing assessment of change rather than a single snapshot
- Used validated, widely recognized instruments (PDAS, PSEQ, HADS, NRS)
- Multivariate analysis isolated the contribution of self-efficacy independent of pain intensity
- Findings were consistent with prior cross-sectional and longitudinal studies linking self-efficacy to disability
Limitations
- Single-center study, limiting generalizability
- Small sample (72) precluded stratifying patients by chronic pain diagnosis
- Selection bias: more than half of identified patients (257) did not return and were excluded; returning patients may have been more satisfied and shown greater self-efficacy improvement
- Short 3-month follow-up examining relatively few factors
- Therapeutic interventions were not controlled or standardized, and no specific self-efficacy-targeted therapy was used, so causation cannot be inferred and self-efficacy may have improved independent of therapy
- Observational design reports associations only; cannot comment on effectiveness of specific therapies
- Two authors are employed by a pharmaceutical company (Pfizer Japan), which provided author salaries
Key Takeaways for Patients
What This Means for You
- 01Building confidence in your ability to do daily activities despite pain (self-efficacy) was linked to less pain-related disability, even when pain intensity itself did not drop much.
- 02In this study, reducing pain alone did not fully explain improvements in everyday function once self-efficacy was taken into account.
- 03Anxiety and depression scores were generally low in this group and were not linked to disability changes here, so this finding may not apply to people with more severe mood symptoms.
- 04Because this was an observational study without a specific self-efficacy therapy, it shows an association, not proof that a particular treatment caused the improvement.
- 05Approaches that may help build self-efficacy, such as cognitive behavioral therapy, activity pacing, and motivational support, are mentioned by the authors as worth exploring with your clinician.