Self-efficacy and Affect as Mediators Between Pain Dimensions and Emotional Symptoms and Functional Limitation in Women With Fibromyalgia

Cecilia Peñacoba Puente, PhD; Lilian Velasco Furlong, PhD; Carmen Écija Gallardo, PhD; Margarita Cigarán Méndez, PhD; Dolores Bedmar Cruz, MD; César Fernández-de-las-Peñas, PhD

Disclosures

Pain Manag Nurs. 2015;16(1):60-68.

Abstract and Introduction

Abstract

The aim of this study was to investigate the role of self-efficacy and affect as mediators of the relationship between pain and several fibromyalgia (FM) symptoms (functional limitation, depression, and anxiety). We evaluated 144 women with FM for self-reported pain (numerical pain scale), pressure pain sensitivity (pressure pain thresholds), functional limitation (Fibromyalgia Impact Questionnaire), self-efficacy (Chronic Pain Self-Efficacy Scale), depression-anxiety (Hospital Anxiety and Depression Scale), and positive-negative affect (Positive-Negative Affect Scale). Mediating analyses were conducted with ordinary least squares multiple regression analysis. The results demonstrated that self-reported pain and pressure pain sensitivity exhibited significant relationships with functional limitation, anxiety, depression, self-efficacy, and affect. Affect mediated the relationship between pressure pain sensitivity and anxiety, whereas self-efficacy was the mediating variable between self-reported pain and functional limitation and depression. Our results support a complex nature of pain in women presenting with FM, as cognitive and emotional variables have different mediator relationships between pain dimensions and functional and emotional outcomes in women with FM.

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Table 1. Correlations Among Variables
Variables	Mean (SD)	2	3	4	5	6	7	8	9	10
1. PPT	142.72 (65.57)	–.200	−.341*	−.332*	−.213	.279*	−.412†	.050	.144	.153
2. NPS (0-10)	6.82 (1.17)		409†	305†	.277*	−.109	.216	−.403†	−.296*	−.307†
3. FIQ	13.06 (6.24)		(.88)	.060	.240*	−.243*	.250*	−.604†	−.376†	−.375†
4. Anxiety	19.76 (3.56)			(.78)	.582†	−.211	.339†	−.157	−.259*	−.105
5. Depression	17.78 (3.13)				(.72)	−.331†	.296†	−.327†	−.317†	−.263*
6. Positive affect	26.09 (7.74)					(.89)	−.528†	.319†	.477†	.337†
7. Negative affect	26.76 (8.35)						(.88)	−.328†	−.439†	−.215*
8. Self-efficacy physical functioning	30.87 (14.51)							(.88)	.694†	.701†
9. Self-efficacy symptoms	36.42 (15.84)								(.87)	.699†
10. Self-efficacy pain	16.44 (11.10)									(.86)

PPT = pressure pain thresholds; NPS = numerical pain scale; FIQ = Fibromyalgia Impact Questionnaire.
The coefficient α for each scale is presented along the diagonal.
*p < .05.
†p < .01.

Table 2. Mediation Model Pain-Self-efficacy-FM outcomes
FM Outcomes	F	R ²	IncR²	Beta	t
Functional limitation (FIQ)
Step 1: NPS	11.722^‡	0.145		0.399 (0.150)*	3.424^‡
Step 2: Self-efficacy physical function	16.348^‡	0.328	0.183	−0.502	−4.219^‡
Step 1: NPS	10.789^‡	0.149		0.405 (0.318)	3.285^‡
Step 2: Self-efficacy physical function	7.396^‡	0.186	0.037	−0.242	−1.874†
Depression
Step 1: NPS	6.544†	0.084	0.066	0.291(0.179)*	2.558†
Step 2: Self-efficacy physical function	6.175^‡	0.150		−0.279	−2.324†
Step 1: NPS	5.644†	0.068	0.051	0.287(0.210)*	2.376†
Step 2: Self-efficacy pain	5.310^‡	0.119		−0.264	−2.156†

FIQ = Fibromyalgia Impact Questionnaire; NPS = numerical pain scale
Standardized regression coefficients (betas) are derived from the step in which they were added to the equation.
*Beta value after introduction of mediating variable. Significant Beta weight comparisons in Step 2 using Sobel's test are presented in bold.
^† p < .05; ^‡p < .01

Table 3. Mediation Model Pain–Affect–FM Outcomes
FM Outcomes	F	R²	IncR²	β	t
Anxiety
Step 1: PPT	5.959†	0.110		−0.332 (−0.026)*	−2.441†
Step 2: Negative affect	23.756‡	0.508	0.398	0.701	6.158‡

PPT = pressure pain thresholds.
Standardized regression coefficients (β) are derived from the step in which they were added to the equation.
*β value after introduction of mediating variable.
†p < .05.
‡p < .01.