Disability and depression in patients with chronic pain: Pain or pain-related beliefs?

Background: Physical disability and depression in patients with chronic pain have been shown to be associated with pain intensity and pain self-efficacy beliefs. However, little is known about whether pain self-efficacy beliefs can predict depression and physical disability when this relationship is controlled for pain intensity and other related demographic variables The aim of the current study was to replicate and extend previous research on the relationship between pain-related beliefs, depression, and disability by examining these relationships in a heterogeneous sample of Iranian patients with chronic pain. Methods: A group of 430 patients with chronic pain participated in the study and completed questionnaires on demographic variables, pain intensity, pain self-efficacy beliefs, physical disability, and depression. Results: Correlation analyses revealed that patients with higher education were less depressed and less physically disabled. Younger patients were more physically disabled. Pain intensity and pain self-efficacy beliefs were significantly related to physical disability and depression. In hierarchical multiple regression analyses, after controlling for patients' background variables and pain intensity, pain self-efficacy beliefs accounted for significant variance in depression and physical disability over and above the effect of demographic variables and pain intensity. Patients with higher pain self-efficacy, compared to those with lower self-efficacy, were less depressed and less physically disabled. Conclusion: Pain self-efficacy was more strongly related to depression and physical disability than pain intensity and demographic variables. The findings of the present study suggest the importance of targeting pain self-efficacy beliefs for modification in treatment of patients with chronic pain.