Pain self-efficacy and fear of movement are similarly associated with pain intensity and disability in Italian patients with chronic low back pain

Objectives: The purpose of this study was to investigate cross-sectional associations of pain self-efficacy and fear of movement with pain intensity and disability in patients with chronic low back pain (CLBP). Methods: 103 adult outpatients with non-specific CLBP were included in the study. Socio-demographic and clinical characteristics were assessed, together with Italian versions of self-reported questionnaires to measure the four constructs of interest. Multiple linear regression models were built with psychosocial constructs as main determinants, and pain intensity and disability as outcomes. Potential confounding of socio-demographic and clinical characteristics was assessed. Results: Pain self-efficacy and fear of movement displayed moderate correlations with pain intensity (r = -0.41 and 0.42, respectively) and disability (-0.55 and 0.54). Association models adjusted for pain intensity showed that both pain self-efficacy (β=-0.35, 95% CI=-0.5;-0.2, R2=41%) and fear of movement (β=0.65, 95% CI=0.36;0.93, R2=40%) are significantly and strongly associated with disability. Pain self-efficacy was no longer significantly associated with pain intensity when disability was added as a confounder to the model, whereas fear of movement retained its significant association (β=0.06, 95% CI=0.00;0.11, R2=30%). No other variables acted as confounders in these associations. Discussion: Pain self-efficacy and fear of movement are very similarly associated to main outcomes in patients with CLBP. The results of this study suggest to consider both psychosocial constructs in the management of these patients. Future studies should investigate whether the same associations can be found in a longitudinal design and whether other variables not measured in this study confound these associations.