Impact of Pain Self-Efficacy on Health Outcomes in High-Impact Chronic Pain: A Longitudinal Study

Dokyoung Sophia You; Edward Lannon; Samsuk Kim; Troy C Dildine; Kenneth A Weber 2nd; Emma Raney; Sean C Mackey

doi:10.1097/AJP.0000000000001295

Impact of Pain Self-Efficacy on Health Outcomes in High-Impact Chronic Pain: A Longitudinal Study

Clin J Pain. 2025 May 6. doi: 10.1097/AJP.0000000000001295. Online ahead of print.

Authors

Dokyoung Sophia You¹, Edward Lannon², Samsuk Kim², Troy C Dildine², Kenneth A Weber 2nd², Emma Raney², Sean C Mackey²

Affiliations

¹ TSET Health Promotion Research Center, Department of Community Medicine, The University of Oklahoma-Tulsa, Tulsa, OK, USA.
² Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.

PMID: 40325564
DOI: 10.1097/AJP.0000000000001295

Abstract

Objectives: High-impact chronic pain (HICP), affecting 36.4% of individuals with chronic pain, significantly limits work, social, and self-care activities. Effective treatments for HICP remain elusive. In addition to pain catastrophizing, growing evidence suggests that pain self-efficacy may be a treatment target for HICP. Our study examines the relative contributions of pain self-efficacy and catastrophizing to health outcomes in patients with HICP.

Methods: A total of 259 patients with chronic pain (154 with HICP; 105 without HICP) completed validated measures at baseline and three months later. These included the Chronic Pain Self-Efficacy Scale (CPSS), the Pain Catastrophizing Scale (PCS), and Patient-Reported Outcomes Measurement Information System (PROMIS) domains for physical health (i.e., pain interference, physical function, fatigue, and sleep disturbance) and psychosocial health (i.e., depression, anxiety, anger, and social isolation).

Results: Repeated measures MANOVA showed a significant group effect (HICP vs. No-HICP), but no significant time or group by time interaction effect. The HICP group reported significantly lower CPSS scores and higher PCS scores than the No-HICP group, alongside worse physical and psychosocial health outcomes (η²=0.076~0.445). Pain self-efficacy explained a greater proportion of group differences in health outcomes (52.9-71.7%) compared to pain catastrophizing (10.1-43.3%). Especially, self-efficacy in activity engagement accounted for the largest health disparities between the groups.

Discussion: Findings highlight pain self-efficacy as a critical treatment target for HICP, with greater predictive utility than pain catastrophizing. Enhancing self-efficacy through tailored interventions may reduce the burden of HICP. Future studies should prioritize self-efficacy-based interventions and explore their scalability and long-term impact.

Keywords: chronic pain; high-impact chronic pain; pain catastrophizing; pain self-efficacy; pain treatment targets.

Grants and funding

K23DA048972/National Insitute on Drug Abuse