Next Article in Journal
Management of Individual Patient Expectations When Starting with Highly Effective CFTR Modulators
Next Article in Special Issue
The Effects of Different Types of Dual Tasking on Balance in Healthy Older Adults
Previous Article in Journal
Kinesio Taping vs. Auricular Acupressure for the Personalised Treatment of Primary Dysmenorrhoea: A Pilot Randomized Controlled Trial
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JPM
Volume 11
Issue 8
10.3390/jpm11080810
jpm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

by
Giorgia Varallo
1,2,
Federica Scarpina
3,4,
Emanuele Maria Giusti
1,2,*,
Carlos Suso-Ribera
5,
Roberto Cattivelli
1,2,
Anna Guerrini Usubini
1,2,
Paolo Capodaglio
6,7 and
Gianluca Castelnuovo
1,2
1
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, 28824 Verbania, Italy
2
Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
3
“Rita Levi Montalcini” Department of Neurosciences, University of Turin, 10124 Turin, Italy
4
Unit of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, 28824 Verbania, Italy
5
Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, 12071 Castellon de la Plana, Spain
6
Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, 28824 Verbania, Italy
7
Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, 10121 Turin, Italy
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2021, 11(8), 810; https://doi.org/10.3390/jpm11080810
Submission received: 26 July 2021 / Revised: 11 August 2021 / Accepted: 17 August 2021 / Published: 19 August 2021
(This article belongs to the Special Issue Personalized Care and Treatment Compliance in Chronic Conditions)
Versions Notes

Abstract

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.

1. Introduction

Fibromyalgia (FM) is a complex chronic pain condition that predominantly affects women [1,2]. It is characterized by widespread pain, fatigue, cognitive impairment, and a decline in physical functioning. Although the aetiology of FM is still unclear, central sensitization might play a crucial role [3,4]. However, an interplay between genetic/biological and psychosocial factors appears to be necessary to explain the development and maintenance of this disease [5,6].
Impaired physical functioning is one of the most critical consequences associated with FM [1,7,8]. Reduced physical functional capacity is a significant obstacle to daily activities [9,10,11] and has a negative effect on the individual’s quality of life [3,12]. For example, women with FM have difficulties performing activities crucial to remaining physically independent, which increases their need for assistance from others [9].
The physical decline associated with FM is further exacerbated when individuals have comorbid obesity [13,14,15]. Obesity is an important condition to consider in FM owing to its high prevalence in this population, which can be partly attributed to the decreased activity levels in individuals with FM [7,13,16]. Obesity contributes to the disability burden associated with FM [13]. In particular, obesity is associated with increased pain severity and decreased physical functioning in FM [13,14,16,17,18]. Individuals with FM and obesity experience severe functional limitations owing to the combination of two issues: persistent pain related to FM and restricted movement imposed by obesity [13,19,20,21]. Thus, both conditions can interact with and exacerbate each other. Specifically, the chronic pain and fatigue associated with FM can lead to sedentary behavior, physical inactivity, and weight gain, which can negatively impact physical health and pain status, creating a vicious cycle [22].
In recent years, there has been a growing consensus on the importance of improving physical functioning rather than just reducing pain severity in people with chronic pain [23,24,25]. Consistent with this idea, efforts are being made to shift the focus of pain management from reducing pain to improving the quality of life [25,26,27]. As a consequence, modifiable psychological factors like pain-related cognitions and beliefs about experience of pain that partly explain individual differences in the adaptation to chronic pain, such as pain catastrophizing and pain acceptance, have gained ground in pain research in the past decades [28,29,30,31,32].
Pain catastrophizing is defined as a set of exaggerated and negative cognitive-emotional responses to actual or anticipated painful sensations [33]. According to the fear-avoidance model, which is a theoretical model developed to outline how pain-related cognitions influence pain experience [34,35,36], pain catastrophizing is a key cognitive factor associated with poor functioning in individuals with chronic pain. Indeed, the tendency to exaggerate and ruminate on pain experiences, combined with the tendency to feel helpless during pain episodes (i.e., pain catastrophizing), are known to lead to fear of movement and activity aversion [36]. As a result, individuals with chronic pain who tend to catastrophize engage in a variety of safety behaviors (i.e., movement avoidance, guarded movement) to prevent the worsening of pain symptoms [37]. Eventually, these behaviors lead to a cycle of avoidance; deconditioning; and, as a result, increased disability [7,38,39].
Pain catastrophizing has been observed in individuals with FM [40] and has been robustly associated with physical impairment in FM and other pain conditions [41,42,43,44]. However, the role of pain catastrophizing in individuals with chronic pain conditions and comorbid obesity remains less clear. Somers et al. reported higher levels of pain catastrophizing in individuals with severe obesity and osteoarthritis compared with individuals with less severe degrees of obesity and overweight [45]. Shelby and colleagues observed that higher levels of pain catastrophizing were associated with higher levels of disability in older adults with overweight, obesity, and osteoarthritis [46]. On the contrary, we recently observed no significant association between pain catastrophizing and physical disability in a sample of individuals with obesity and chronic low back pain [32]. These contradictory and heterogeneous findings could be attributed to the characteristics of participants in terms of age, clinical condition, and level of obesity, among other factors. However, the scarcity of evidence about the role of pain catastrophizing in individuals with FM and comorbid obesity justifies the need for more research.
Pain acceptance is another psychological factor that has received increasing attention in chronic pain research [47]. It refers to the willingness to experience painful sensations without attempting to avoid them, as well as the willingness to continue significant activities despite the presence of pain [48]. While the fear-avoidance model considers pain catastrophizing as a major contributor to pain-related disability, the psychological flexibility model of pain identifies pain acceptance as a key factor underlying individual differences in the pain adaptation [49]. The psychological flexibility model emphasizes the importance of an individual’s ability to flexibly change or persist with a behavior considering personal goals and values in a setting of competing psychological influences (such as acceptance of pain) and situational conditions [49]. Persisting in value-oriented behaviors despite uncomfortable experiences, such as pain, is essential to living a full and meaningful life according to this framework [50]. Indeed, pain acceptance appears to facilitate participation in valued activities and the pursuit of personal goals [51], which results in reduced pain interference with daily activities and less perceived disability [47,51,52].
The combination of both pain catastrophizing and pain acceptance might be important to consider in pain research. Previous studies have generally focused on the identification of psychological factors that have a negative impact on physical functioning in individuals with chronic pain [31,40,53,54,55,56]. However, in recent years, resilience factors have also gained ground in pain research [57]. Pain acceptance has emerged as a crucial component in the adaptation to chronic pain. Pain acceptance is, in fact, increasingly targeted in rehabilitative interventions that emphasize the promotion of resources rather than the restoration or modification of only negative and dysfunctional behaviors [58]. In summary, while pain catastrophizing may act as a barrier to a favorable adaptation to chronic pain (i.e., risk or vulnerability factor), pain acceptance might be a facilitator (i.e., resilience factor) [59].
To date, research into physical functioning in individuals with chronic pain and FM has mostly relied on self-report measures [25,41,60,61,62,63,64,65,66,67,68,69]. Performance-based measures, which focus on actual rather than perceived functional ability, have generally been neglected. Importantly, however, self-report and performance-based measures provide different, but complementary information about physical functioning [70]. Physical function is a multidimensional construct that should encompass both subjective (i.e., self-reported functional capacity) and objective (i.e., impaired movement) aspects [25,71,72,73]. While self-report measures assess what individuals “believe they can do’’, performance-based tests evaluate what they ‘’can actually do’’ [70]. The contribution of psychological factors tends to be greater for subjective aspects that involve a cognitive evaluation (such as perceived functioning) rather than actual performance in daily activities [74]. Therefore, past research might have revealed strong associations between psychological factors and self-report measures of physical functioning because they assessed subjective perceptions. Importantly, performance-based and self-reported physical functions are not significantly correlated in individuals with heterogeneous musculoskeletal chronic pain [71]. In addition, a study highlighted that individuals with FM report worse subjective physical functioning compared with objective performance [75]. Therefore, research that evaluates and compares the contribution of psychological factors to perceived and performance-based functioning outcomes is necessary to advance interdisciplinary interventions for chronic pain.
In summary, the goal of the present study is to investigate the contribution of pain catastrophizing (vulnerability factor) and pain acceptance (resilience factor) to the physical functioning of individuals with FM and comorbid obesity. We hypothesized that pain catastrophizing [41,42,43,52,56] would be associated with reduced physical functioning, while pain acceptance would be associated with better physical functioning [47,60,62,76]. We also hypothesized that the contribution of psychological variables will be greater for perceived versus performance-based functioning [74].

2. Materials and Methods

2.1. Procedure and Participants

A cross-sectional study was conducted. An a priori power analysis was performed using G. Power (version 3.1.9.4) [77] to calculate the required sample size to detect statistical significance. Setting a conservative small-to-medium effect size of the predictors (0.10), an alpha of 0.05, and a power of 0.90, a minimum sample size of n = 130 was required to detect the hypothesized effects.
From January 2019 to September 2019, 160 women were consecutively recruited at the start of a one-month-long hospitalization program for weight loss and physical therapy at the Orthopaedic Rehabilitation Unit of the IRCCS Istituto Auxologico Italiano (Piancavallo, Italy). Data collection was conducted during the first week of the diagnostic assessment, before starting a physical therapy and nutritional rehabilitative program for weight loss.
Participants were included in this study if they (a) had a FM diagnosis provided by a rheumatologist according to Wolfe et al. criteria [1]; (b) met the American College of Rheumatology (ACR) Research Criteria for fibromyalgia [78,79], as measured by the Fibromyalgia Survey Questionnaire in its Italian version [53]; (c) were over 18 years; and (d) were able to sign an informed consent form and could complete the questionnaires.
Patients were excluded if they (a) had psychiatric disorders with psychotic symptoms or severe personality disorders; (b) had previously or were currently receiving psychological treatment for FM; and (c) had comorbid acute pain conditions or comorbid chronic pain conditions different from FM.

2.2. Measures

Sociodemographic and clinical data. Participants completed a self-report protocol that included age, weight (in kilograms), and height (in centimeters), job status (i.e., employed, unemployed, or disability pension), current opioid use, and pain duration (in years).
Fibromyalgia symptomatology. The Italian version of the fibromyalgia survey questionnaire (FSQ) [53] was used to assess the ACR fibromyalgia research criteria [78,79]. This measure, which is recommended in [78,80], was administered to evaluate the level of symptomatology required to confirm the diagnosis of FM. Individuals must meet the following research criteria: (1) widespread pain index ≥7 and symptom severity scale score ≥5 OR widespread pain index of 4–6 and symptom severity scale score ≥9; (2) symptoms have generally been present for at least 3 months.
Pain severity. The numeric pain rating scale (NPRS) [81] was used to assess pain severity levels. It consists of an 11-point scale (anchors 0 = “no pain”; 10 = “worst possible pain”). The Numeric Pain Rating Scale is a well-validated and widely used measure of pain severity in chronic pain conditions [82].
Pain catastrophizing. The pain catastrophizing scale (PCS) [83] is a self-report measure of pain-related catastrophic thinking. It consists of 13 items on a five-point Likert scale (from 0 = “not at all” to 4 = “all the time”). The total score ranges from 0 to 52, with higher scores indicating higher levels of pain catastrophizing [84]. The Italian version [84] has psychometric properties comparable with the original version. In the current study, internal consistency was excellent (Cronbach’s α = 0.89).
Pain acceptance. The chronic pain acceptance questionnaire (CPAQ) is a measure of pain acceptance [85,86,87] that consists of 20 items scored on a 7-point Likert scale (0 = “never true” to 6 = “always true”). The maximum total score is 120, with higher scores indicating greater acceptance. The Italian version of the questionnaire was used [88], which, in line with the original version, has obtained good psychometric properties. In the present study, the internal consistency of this measure was excellent (Cronbach’s α = 0.90).
Self-report physical functioning limitations. Self-reported physical functioning limitations were assessed using the physical functioning subscale of the fibromyalgia impact questionnaire—revised (PF-FIQR). The FIQR is a 21-item measure. The items use an 11-point numeric rating scale ranging from 0 to 10, with 10 representing “worst” functioning scores. All questions are related to the functioning of the last 7 days. Higher total scores indicate a higher impact of the disease and worse functioning. The FIQR assesses three domains: (a) ‘physical function’, (b) ‘overall impact’, and (c) ‘symptoms’. The total score, which assesses the impact of FM on overall functioning, can also be computed. Considering the aim of the present study, the physical function subscale was used. Specifically, the physical functioning subscale of the FIQR includes nine items developed to evaluate the level of physical impairment. This scale has been used in previous research [38,75,89,90]. Scores on the physical functioning subscale of the FIQR range from 0 to 30, with higher scores indicating worse physical functioning. The FIQR and its subscales have good psychometric properties and good discriminant ability [38]. In the current study, internal consistency was good (Cronbach’s α = 0.82).
Performance-based physical functioning. The 6-min walking test (6MWT) is a performance-based test used to evaluate the ability to walk and is a simple and inexpensive measure of physical functioning. The 6MWT has been used in research with persons with FM [38,90,91] with good applicability and reliability findings [38,92]. In this test, the participant is required to walk for six minutes along a rectangular course of 45.7 m. Walking distance in meters is measured with higher scores, indicating better physical performance. The distance walked during the 6MWT has been found to be shorter in females with FM compared with healthy women (i.e., discriminant validity) [9]. Furthermore, the 6MWT has good reproducibility and is recommended for the assessment of walking ability in individuals with obesity [93]. Women with obesity have also been found to walk significantly shorter distances during the 6MWT compared with their normal-weight counterparts [94,95].

2.3. Statistical Analysis

Counts and percentages were used to describe categorical variables, whereas means and standard deviations were used to describe continuous variables. Height in meters and weight in kilograms were used to compute body mass index (i.e., BMI, as the weight in kilograms divided by the square of height in meters (kg/m2) [96]), which is considered as an indicator of obesity (BMI ≥ 30) [96].
Pearson bivariate analyses were performed to evaluate the associations between the numeric pain rating scale (i.e., pain severity), the pain catastrophizing scale (i.e., pain catastrophizing), the chronic pain acceptance questionnaire (i.e., pain acceptance), the physical functioning scale of the fibromyalgia impact questionnaire (i.e., self-reported physical functioning), and the 6-min walking test (i.e., performance-based physical functioning).
To answer our research question, we used multivariate hierarchical regression analyses, as done in previous studies [28,29,33,34]. Before the multivariate regression, we checked the assumptions of normality, linearity, homoscedasticity, and multicollinearity of the data. To evaluate the contribution of pain catastrophizing and pain acceptance, self-reported physical functioning limitations and performance-based physical functioning were independently introduced as dependent factors in two separate regressions. In both models, age [97,98], opioid use [98,99], and pain duration [100,101] were entered into the first step as covariates to control for their relationship with the outcome measures. Pain severity was entered in the second step, because of its association with physical functioning [38,102]. Pain catastrophizing and pain acceptance were entered simultaneously in the third and last step. The change in explained variance (∆R2) was used to evaluate the additional variance of the dependent variables accounted for by the variables included in each block. The significance was evaluated using a criterion of p < 0.05. Data were analyzed using the Jamovi software [103].

3. Results

The participant’s characteristics are reported in Table 1.

3.1. Correlations

Pearson’s correlations between measures are reported in Table 2. Pain catastrophizing and pain acceptance were significantly and negatively correlated (r = −0.49, p < 0.001). Pain catastrophizing was significantly and positively associated with pain severity (r = 0.42, p < 0.001), perceived limitations in physical functioning (r = 0.43, p < 0.001), and performance-based physical functioning (r = −0.57, p < 0.001). On the contrary, pain acceptance was significantly and negatively related to pain severity (r = −0.39, p < 0.001) and limitations in physical functioning (r = −0.47, p < 0.001), and linked to improved performance-based physical functioning (r = 0.52, p < 0.001). Perceived physical limitations and performance-based physical functioning were correlated in the negative direction (r = −0.53, p < 0.001), because higher scores on the self-report physical functioning limitations measure correspond to greater disability, while higher scores on the performance-based test reflect better physical functioning.

3.2. Hierarchical Regression Relative to Self-Reported Physical Functioning Limitations

The first multivariate hierarchical regression was conducted using self-report physical functioning limitations as the dependent variable (Table 3). The demographic characteristics (i.e., pain duration, age, current opioid use, and body mass index) included in the first step explained a nonsignificant 4% (R2 = 0.04) variance in self-report physical functioning limitations in the first step (F (4155) = 1.78; p = 0.14). Pain severity, which was included in the second step, significantly contributed an additional 12% of the explained variance (ΔF (1154) = 22.60; p < 0.001; ΔR2 = 0.12) of self-report physical functioning limitations. The third step, which included pain catastrophizing and pain acceptance, significantly explained an additional 17% of the variance of self-reported physical functioning limitations (ΔF (2152) = 20.10; p < 0.001; ΔR2 = 0.17).
In the final model, opioid use (B = 2.66, p = 0.006), pain acceptance (B = −0.13, p < 0.001), and pain catastrophizing (B = 0.12, p ≤ 0.001) contributed unique variance to the prediction of self-reported physical functioning limitations. Pain severity, which was significantly associated with self-report physical functioning limitations in the second step, became nonsignificant when accounting for the contribution of pain catastrophizing and pain acceptance.

3.3. Hierarchical Regression Relative to Performance-Based Physical Functioning

A second multivariate hierarchical regression was conducted using performance-based physical functioning as the dependent variable (Table 4). The first step, which included demographic variables (i.e., pain duration, age, current opioid use, body mass index), explained a significant 12% (R2 = 0.12) variance in performance-based physical functioning (F (4155) = 5.23, p ≤ 0.001). In the second step, pain severity contributed an additional 14% variance in performance-based physical functioning (ΔF (1154) = 28.9; p < 0.001; ΔR2 = 0.139). Next, pain catastrophizing and pain acceptance included in the third step significantly explained an additional 23% variance of performance-based physical functioning (ΔF (2152) = 33.3; p < 0.001; ΔR2 = 0.226).
Pain duration, current opioid use, and pain severity were significantly associated with performance-based physical functioning in the final model. Additionally, both pain catastrophizing (B = −0.364; p < 0.001) and pain acceptance (B = 0.272; p ≤ 0.001) uniquely and significantly contributed to performance-based physical functioning.

4. Discussion

In this study, we aimed to explore the association between pain catastrophizing and pain acceptance with self-reported and performance-based physical functioning in individuals with FM and obesity. We confirmed our hypothesis that higher pain catastrophizing and lower pain acceptance would be significantly associated with poorer physical functioning when assessed with a self-reported and a performance-based measure. Specifically, both pain catastrophizing and pain acceptance were significant predictors of self-reported and performance-based physical functioning, even after controlling for body mass index, pain duration, current opioid use, and pain severity. Contrary to our hypotheses, however, the contribution of psychological variables was stronger for performance-based compared with self-reported physical functioning.
Research has repeatedly shown that pain catastrophizing and pain acceptance are important predictors of self-reported physical functioning in samples with acute [104,105] and chronic pain [105,106], including FM [41,107,108,109,110]. Our findings are consistent with the previous evidence. Previous research, however, has primarily focused on subjective measures of functional capacity. Our work contributes to the literature by combining a self-reported measure with a performance-based test that provides a more objective evaluation of physical functioning. The present study revealed that psychological factors contribute not only to perceived physical functioning, but also to actual functioning. Importantly, both pain catastrophizing and pain acceptance uniquely contributed to the prediction of self-reported and performance-based functioning, implying that the two factors are likely to influence physical functioning via distinct pathways. Ultimately, the fact that the two psychological factors contributed significantly to physical functioning when included in the same multivariate analysis supports the idea that they should both be independently targeted in multidisciplinary interventions. In addition, this contributes to the validity of different psychological models to understand the pain experience, such as the fear-avoidance model and the psychological flexibility model.
Individuals who catastrophize tend to appraise pain as a catastrophic and harmful experience and frequently ruminate and feel hopeless about it [43,111]. Based on the present results, the tendency to catastrophize about pain might negatively affect both the individual’s perception of what they are capable of accomplishing in terms of physical performance (i.e., what I think I can do) as well as their actual physical performance (i.e., what I can do). We propose a mechanism to explain why this might occur. Pain catastrophizing might increase the level of attention and awareness of painful sensations [112], thus increasing protective behaviors. Individuals with chronic pain who catastrophize engage in a variety of safety behaviors (e.g., activity avoidance, movement restriction, and guarded movement) to prevent the worsening of pain symptoms [37]. Obesity, in turn, might increase avoidance in chronic musculoskeletal pain conditions [113]. In particular, the belief that excessive weight causes additional damage or increases pain might play an additional role in restricting activity, which, combined with skin friction, discomfort, and respiratory difficulties [114], might result in the avoidance of movements and, in turn, impediment to weight loss [113].
On the other hand, the willingness to persist with important activities without attempting to avoid pain (i.e., acceptance) might have a positive influence on both subjective and actual physical functioning [47,51,52]. Individuals who accept pain as an unpleasant experience that they are willing to undergo in order to achieve their goals might be more likely to move and engage in valued activities despite the pain. In addition, acceptance might facilitate the adaptation to chronic pain by focusing on one’s personal goals rather than on pain control, thereby preventing the implementation of pain-avoidance behaviors [47,51,52]. Taking all the previous points into account, reducing pain catastrophizing and enhancing pain acceptance by implementing psychological interventions might help individuals with chronic pain to reduce the adoption of unnecessary and detrimental protective behaviors that perpetuate a cycle of avoidance, deconditioning, and increased disability [7,38,39].
Interestingly, we observed that the self-reported measure of physical function and the performance-based test were significantly and moderately related. Our results are consistent with those of Mannerkorpi and colleagues [38], but not with the findings of Greenberg and colleagues, who found no significant relationship between subjective and objective measures of physical functioning in individuals with heterogeneous chronic pain [71]. These discrepancies could be owing to differences in sample characteristics or measurements used across studies, or they might suggest that the relationship between subjective and objective components of physical functioning might be modulated differently in clinical conditions. While acknowledging this, owing to the scarcity of existing studies, more research is still needed to determine the extent to which self-report and objective measures of functioning are associated in different populations. Such studies are important because they investigate whether a subjective assessment of physical functioning can be used as a reliable alternative measure in objective tests of physical functioning, which are generally more time-consuming.
An interesting and unexpected finding was that the contribution of psychological factors was greater for performance-based physical functioning as opposed to self-reported physical functioning, while psychological aspects have a greater impact on factors that require cognitive evaluation [74]. One possible explanation for the findings is that the performance-based test might be interpreted as both pain-provoking and/or actually painful to perform. Thus, attention directed at a potential or actual pain-inducing movement might activate the repertoire of pain-related cognitive/coping strategies in a more prominent and influential way to motivate different behaviors. For example, individuals who tend to catastrophize about pain might be encouraged to restrict movement when they experience pain in real-world contexts, while those who accept pain might be prompted to persist in movement in this same scenario. More studies are needed to confirm this hypothesis, which could lead to an interesting line of future research.
Body mass index was not significantly related to self-reported and performance-based physical functioning. This result contradicted previous evidence [13,115,116]. It should be noted, however, that the variability in body mass index was limited in our sample because only individuals with obesity were included. In addition, recent studies have argued that body mass index may be an inadequate and oversimplified measure that does not properly capture the complexity of obesity [117,118]. Different indices of obesity could be used in future studies, such as the level of adiposity and the distribution of adipose tissue [119,120].
Among other control factors, current opioid use was found to be significantly associated with both self-reported and performance-based physical functioning. Individuals who are currently on opioid therapy might rely on this medication because of their low level of both subjective and objective physical functioning. Instead, pain duration and pain severity were only significantly related to performance-based physical functioning. The biological function of pain is to alter behavior by prioritizing protection and avoidance [121], and it seems likely that pain has a more pronounced effect on physical performance than on its perception [122]. Relative to pain duration, it is possible that individuals with a longer history of chronic pain have implemented dysfunctional coping strategies over the years (such as avoidance of movement and activities due to pain persistence despite treatment) that lead to the development of deconditioning and disuse, thus worsening the actual ability to move [35,123].
The findings of this study could have several clinical implications. According to our results, measures of pain catastrophizing and pain acceptance should be included in the assessment of biopsychosocial aspects of pain in FM and obesity to provide a more complete picture of the factors that significantly affect physical functioning. Furthermore, our findings suggest that pain catastrophizing and pain acceptance should be treatment targets in psychological evidence-based intervention to improve physical functioning in individuals with FM, and obesity should include pain catastrophizing and pain acceptance as treatment targets. In support of this hypothesis, Baranoff and colleagues [47] highlighted how changes in pain catastrophizing and pain acceptance accounted for changes in self-reported and performance-based disability in individuals with chronic pain, primarily located in the lower back. Importantly, because both pain catastrophizing and pain acceptance are significant predictors of both perceived and actual physical functioning, multidisciplinary interventions targeting both factors are likely to improve both aspects of functional capacity. More research is required to test this hypothesis in individuals with FM, especially when it is associated with obesity.
Finally, it is important to note that the willingness to move and engage in physical activity is critical in the management of both FM and obesity. Physical activity improves physical functioning in individuals with FM [124,125,126,127,128,129] as well as in those with obesity [130,131,132]. Consequently, current and previous research supports the idea that it might be beneficial to reduce pain catastrophizing and enhance pain acceptance in order to promote adherence to physical activity and a healthy, active lifestyle in individuals with FM and obesity. More research is needed to determine what other factors might be important in promoting physical activity compliance.
This study has some limitations. We did not include a control group (for example, individuals who are only affected by FM or obesity). In addition, we focused only on two psychological factors. While both are important factors according to the pain literature, other psychological factors, such as kinesiophobia [31] or pain self-efficacy [133], might also play a role in physical functioning. Furthermore, while the self-report questionnaire used referred to a period in the past (e.g., the previous week), the performance-based measure was based on the present moment. While most available measures refer to this timeframe, the development of self-reported measures that refer to the current time of assessment could be used to mitigate this mismatch. In addition, the pain severity measure used in this study assesses the intensity of perceived pain at the time of completion. As there can be variability in the levels of perceived pain in fibromyalgia even within a single day [134,135,136], measures that assess medial pain intensity over a week could be implemented to address this limitation. Finally, because we focused on individuals with FM and obesity as a comorbid condition, the findings might not be generalizable to other populations.

5. Conclusions

Our findings suggest that pain catastrophizing and pain acceptance should be addressed to improve performance-based and self-reported physical functioning in individuals with FM and obesity. If these components are ignored, rehabilitative interventions may neglect critical factors associated with the maintenance of poor physical functioning and physical health.

Author Contributions

G.V. conceived and designed the study protocol and performed the data collections with R.C. and A.G.U.; G.V. carried out literature searches; G.V. designed and carried out the statistical analysis; G.V. drafted the manuscript; G.V., F.S., E.M.G. and C.S.-R. interpreted the data; F.S., E.M.G. and C.S.-R. collaborated in drafting the manuscript; P.C. supervised the enrollment of participants; E.M.G. and G.C. supervised the psychological data collection. All authors critically reviewed and contribute to the final version of the paper. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki of 1975, as revised in 1983, and approved by the Ethics Committee of Instituto Auxologico Italiano (code V.0.4 30-05-2017).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available because they contain information that could compromise the privacy of research participants.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.-A.; Goldenberg, D.L.; Häuser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [Google Scholar] [CrossRef]
  2. Marques, A.P.; Santo, A.D.S.D.E.; Berssaneti, A.A.; Matsutani, L.A.; Yuan, S.L.K. Prevalence of fibromyalgia: Literature review update. Rev. Bras. Reum. 2017, 57, 356–363. [Google Scholar] [CrossRef]
  3. Clauw, D.J. Fibromyalgia. JAMA 2014, 311, 1547–1555. [Google Scholar] [CrossRef] [PubMed]
  4. Siracusa, R.; Paola, R.; Cuzzocrea, S.; Impellizzeri, D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci. 2021, 22, 3891. [Google Scholar] [CrossRef] [PubMed]
  5. Stisi, S.; Cazzola, M.; Buskila, D.; Spath, M.; Giamberardino, M.; Sarzi-Puttini, P.; Arioli, G.; Alciati, A.; Leardini, G.; Gorla, R.; et al. Etiopathogenetic mechanisms of fibromyalgia syndrome. Reumatismo 2011, 60, 25–35. [Google Scholar] [CrossRef]
  6. Ghiggia, A.; Torta, R.; Tesio, V.; Di Tella, M.; Romeo, A.; Colonna, F.; Geminiani, G.C.; Fusaro, E.; Batticciotto, A.; Castelli, L. Psychosomatic syndromes in fibromyalgia. Clin. Exp. Rheumatol. 2017, 35, 106–111. [Google Scholar] [PubMed]
  7. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. [Google Scholar] [CrossRef] [PubMed]
  8. Turk, D.C.; Dworkin, R.H.; Revicki, D.; Harding, G.; Burke, L.B.; Cella, D.; Cleeland, C.S.; Cowan, P.; Farrar, J.T.; Hertz, S.; et al. Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain. Pain 2008, 137, 276–285. [Google Scholar] [CrossRef] [PubMed]
  9. Jones, J.; Rutledge, D.N.; Jones, K.D.; Matallana, L.; Rooks, D.S. Self-Assessed Physical Function Levels of Women with Fibromyalgia: A National Survey. Women’s Health Issues 2008, 18, 406–412. [Google Scholar] [CrossRef]
  10. Kingsley, J.D.; Panton, L.B.; Toole, T.; Sirithienthad, P.; Mathis, R.; McMillan, V. The Effects of a 12-Week Strength-Training Program on Strength and Functionality in Women with Fibromyalgia. Arch. Phys. Med. Rehabil. 2005, 86, 1713–1721. [Google Scholar] [CrossRef]
  11. Verbunt, J.A.; Pernot, D.H.; Smeets, R.J. Disability and quality of life in patients with fibromyalgia. Health Qual. Life Outcomes 2008, 6, 8. [Google Scholar] [CrossRef]
  12. Costa, I.D.S.; Gamundí, A.; Miranda, J.G.V.; França, L.G.S.; De Santana, C.N.; Montoya, P. Altered Functional Performance in Patients with Fibromyalgia. Front. Hum. Neurosci. 2017, 11, 14. [Google Scholar] [CrossRef]
  13. Okifuji, A.; Donaldson, G.W.; Barck, L.; Fine, P.G. Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep. J. Pain 2010, 11, 1329–1337. [Google Scholar] [CrossRef]
  14. Aparicio, V.A.; Ortega, F.B.; Carbonell-Baeza, A.; Camiletti, D.; Ruiz, J.R.; Delgado-Fernández, M. Relationship of Weight Status with Mental and Physical Health in Female Fibromyalgia Patients. Obes. Facts 2011, 4, 443–448. [Google Scholar] [CrossRef]
  15. Kim, C.-H.; Luedtke, C.A.; Vincent, A.; Thompson, J.M.; Oh, T.H. Association of body mass index with symptom severity and quality of life in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 222–228. [Google Scholar] [CrossRef] [PubMed]
  16. Vincent, A.; Clauw, D.; Oh, T.H.; Whipple, M.O.; Toussaint, L.L. Decreased Physical Activity Attributable to Higher Body Mass Index Influences Fibromyalgia Symptoms. PM&R 2014, 6, 802–807. [Google Scholar] [CrossRef]
  17. Kim, C.-H.; Luedtke, C.A.; Vincent, A.; Thompson, J.M.; Oh, T.H. Association Between Body Mass Index and Response to a Brief Interdisciplinary Treatment Program in Fibromyalgia. Am. J. Phys. Med. Rehabil. 2012, 91, 574–583. [Google Scholar] [CrossRef] [PubMed]
  18. Arranz, L.; Canela, M.; Rafecas, M.; Rafecas, M. Relationship between body mass index, fat mass and lean mass with SF-36 quality of life scores in a group of fibromyalgia patients. Rheumatol. Int. 2011, 32, 3605–3611. [Google Scholar] [CrossRef] [PubMed]
  19. D’Onghia, M.; Ciaffi, J.; Lisi, L.; Mancarella, L.; Ricci, S.; Stefanelli, N.; Meliconi, R.; Ursini, F. Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. Semin. Arthritis Rheum. 2021, 51, 409–424. [Google Scholar] [CrossRef] [PubMed]
  20. Wearing, S.C.; Hennig, E.; Byrne, N.; Steele, J.; Hills, A.P. The biomechanics of restricted movement in adult obesity. Obes. Rev. 2006, 7, 13–24. [Google Scholar] [CrossRef]
  21. Larsson, U.E.; Mattsson, E. Functional limitations linked to high body mass index, age and current pain in obese women. Int. J. Obes. 2001, 25, 893–899. [Google Scholar] [CrossRef]
  22. Okifuji, A.; Hare, B. The association between chronic pain and obesity. J. Pain Res. 2015, 8, 399–408. [Google Scholar] [CrossRef]
  23. Turk, D.C.; Dworkin, R.H.; Allen, R.R.; Bellamy, N.; Brandenburg, N.; Carr, D.B.; Cleeland, C.; Dionne, R.; Farrar, J.T.; Galer, B.S.; et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 2003, 106, 337–345. [Google Scholar] [CrossRef] [PubMed]
  24. Turk, D.C.; Dworkin, R.H. What should be the core outcomes in chronic pain clinical trials? Arthritis Res. Ther. 2004, 6, 151–154. [Google Scholar] [CrossRef] [PubMed][Green Version]
  25. Jackson, W.; Zale, E.L.; Berman, S.J.; Malacarne, A.; Lapidow, A.; Schatman, M.E.; Kulich, R.; Vranceanu, A.-M. Physical functioning and mindfulness skills training in chronic pain: A systematic review. J. Pain Res. 2019, 12, 179–189. [Google Scholar] [CrossRef] [PubMed]
  26. Severeijns, R.; Vlaeyen, J.; Hout, M.A.V.D.; Weber, W.E. Pain Catastrophizing Predicts Pain Intensity, Disability, and Psychological Distress Independent of the Level of Physical Impairment. Clin. J. Pain 2001, 17, 165–172. [Google Scholar] [CrossRef] [PubMed]
  27. Pincus, T.; Burton, A.K.; Vogel, S.; Field, A. A Systematic Review of Psychological Factors as Predictors of Chronicity/Disability in Prospective Cohorts of Low Back Pain. Spine 2002, 27, E109–E120. [Google Scholar] [CrossRef]
  28. Gatchel, R.J.; Peng, Y.B.; Peters, M.; Fuchs, P.; Turk, D.C. The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychol. Bull. 2007, 133, 581–624. [Google Scholar] [CrossRef]
  29. Segura-Jiménez, V.; Borges-Cosic, M.; Soriano-Maldonado, A.; Estévez-López, F.; Alvarez-Gallardo, I.C.; Herrador-Colmenero, M.; Delgado-Fernández, M.; Ruiz, J.R. Association of sedentary time and physical activity with pain, fatigue, and impact of fibromyalgia: The al-Ándalus study. Scand. J. Med. Sci. Sports 2015, 27, 83–92. [Google Scholar] [CrossRef] [PubMed]
  30. Crombez, G.; Vlaeyen, J.; Heuts, P.H.; Lysens, R. Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain 1999, 80, 329–339. [Google Scholar] [CrossRef]
  31. Varallo, G.; Scarpina, F.; Giusti, E.M.; Cattivelli, R.; Usubini, A.G.; Capodaglio, P.; Castelnuovo, G. Does Kinesiophobia Mediate the Relationship between Pain Intensity and Disability in Individuals with Chronic Low-Back Pain and Obesity? Brain Sci. 2021, 11, 684. [Google Scholar] [CrossRef] [PubMed]
  32. Varallo, G.; Giusti, E.M.; Scarpina, F.; Cattivelli, R.; Capodaglio, P.; Castelnuovo, G. The Association of Kinesiophobia and Pain Catastrophizing with Pain-Related Disability and Pain Intensity in Obesity and Chronic Lower-Back Pain. Brain Sci. 2020, 11, 11. [Google Scholar] [CrossRef]
  33. Quartana, P.J.; Campbell, C.M.; Edwards, R.R. Pain catastrophizing: A critical review. Expert Rev. Neurother. 2009, 9, 745–758. [Google Scholar] [CrossRef] [PubMed]
  34. Keefe, F.J.; Rumble, M.E.; Scipio, C.D.; Giordano, L.A.; Perri, L.M. Psychological aspects of persistent pain: Current state of the science. J. Pain 2004, 5, 195–211. [Google Scholar] [CrossRef]
  35. Leeuw, M.; Goossens, M.; Linton, S.J.; Crombez, G.; Boersma, K.; Vlaeyen, J. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. J. Behav. Med. 2006, 30, 77–94. [Google Scholar] [CrossRef]
  36. Crombez, G.; Eccleston, C.; Van Damme, S.; Vlaeyen, J.; Karoly, P. Fear-Avoidance Model of Chronic Pain. Clin. J. Pain 2012, 28, 475–483. [Google Scholar] [CrossRef]
  37. Vlaeyen, J.W.; Linton, S.J. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain 2000, 85, 317–332. [Google Scholar] [CrossRef]
  38. Mannerkorpi, K.; Svantesson, U.; Broberg, C. Relationships Between Performance-Based Tests and Patients’ Ratings of Activity Limitations, Self-Efficacy, and Pain in Fibromyalgia. Arch. Phys. Med. Rehabil. 2006, 87, 259–264. [Google Scholar] [CrossRef]
  39. Gaudreault, N.; Boulay, P. Cardiorespiratory fitness among adults with fibromyalgia. Breathe 2018, 14, e25–e33. [Google Scholar] [CrossRef]
  40. Edwards, R.R.; Cahalan, C.; Mensing, G.; Smith, M.T.; Haythornthwaite, J.A. Pain, catastrophizing, and depression in the rheumatic diseases. Nat. Rev. Rheumatol. 2011, 7, 216–224. [Google Scholar] [CrossRef] [PubMed]
  41. Paschali, M.; Lazaridou, A.; Paschalis, T.; Napadow, V.; Edwards, R. Modifiable Psychological Factors Affecting Functioning in Fibromyalgia. J. Clin. Med. 2021, 10, 803. [Google Scholar] [CrossRef]
  42. Suso-Ribera, C.; García-Palacios, A.; Botella, C.; Ribera-Canudas, M.V. Pain Catastrophizing and Its Relationship with Health Outcomes: Does Pain Intensity Matter? Pain Res. Manag. 2017, 2017, 9762864. [Google Scholar] [CrossRef]
  43. Edwards, R.R.; Bingham, C.O.; Bathon, J.; Haythornthwaite, J.A. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Care Res. 2006, 55, 325–332. [Google Scholar] [CrossRef] [PubMed]
  44. Larice, S.; Ghiggia, A.; Di Tella, M.; Romeo, A.; Gasparetto, E.; Fusaro, E.; Castelli, L.; Tesio, V. Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scand. J. Psychol. 2019, 61, 271–280. [Google Scholar] [CrossRef] [PubMed]
  45. Somers, T.J.; Keefe, F.J.; Carson, J.W.; Pells, J.J.; Lacaille, L. Pain catastrophizing in borderline morbidly obese and morbidly obese individuals with osteoarthritic knee pain. Pain Res. Manag. 2008, 13, 401–406. [Google Scholar] [CrossRef]
  46. Shelby, R.A.; Somers, T.J.; Keefe, F.J.; Pells, J.J.; Dixon, K.E.; Blumenthal, J.A. Domain Specific Self-Efficacy Mediates the Impact of Pain Catastrophizing on Pain and Disability in Overweight and Obese Osteoarthritis Patients. J. Pain 2008, 9, 912–919. [Google Scholar] [CrossRef] [PubMed]
  47. Baranoff, J.; Hanrahan, S.; Kapur, D.; Connor, J. Acceptance as a process variable in relation to catastrophizing in multidisciplinary pain treatment. Eur. J. Pain 2012, 17, 101–110. [Google Scholar] [CrossRef]
  48. Thompson, M.; McCracken, L.M. Acceptance and Related Processes in Adjustment to Chronic Pain. Curr. Pain Headache Rep. 2011, 15, 144–151. [Google Scholar] [CrossRef]
  49. Vowles, K.; McCracken, L.; Sowden, G.; Ashworth, J. Psychological Flexibility in Coping with Chronic Pain: Further examination of the brief pain coping inventory-2. Clin. J. Pain 2014, 30, 324–330. [Google Scholar] [CrossRef]
  50. McCracken, L.M.; Morley, S. The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management. J. Pain 2014, 15, 221–234. [Google Scholar] [CrossRef]
  51. McCracken, L.M. Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998, 74, 21–27. [Google Scholar] [CrossRef]
  52. Vowles, K.E.; McCracken, L.M.; Eccleston, C. Patient functioning and catastrophizing in chronic pain: The mediating effects of acceptance. Health Psychol. 2008, 27, S136–S143. [Google Scholar] [CrossRef]
  53. Varallo, G.; Ghiggia, A.; Arreghini, M.; Capodaglio, P.; Manzoni, G.M.; Giusti, E.M.; Castelli, L.; Castelnuovo, G. The Reliability and Agreement of the Fibromyalgia Survey Questionnaire in an Italian Sample of Obese Patients. Front. Psychol. 2020, 12, 187. [Google Scholar] [CrossRef]
  54. Marshall, P.W.M.; Schabrun, S.; Knox, M.F. Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS ONE 2017, 12, e0180788. [Google Scholar] [CrossRef] [PubMed]
  55. Giusti, E.M.; Manna, C.; Varallo, G.; Cattivelli, R.; Manzoni, G.M.; Gabrielli, S.; D’Amario, F.; Lacerenza, M.; Castelnuovo, G. The Predictive Role of Executive Functions and Psychological Factors on Chronic Pain after Orthopaedic Surgery: A Longitudinal Cohort Study. Brain Sci. 2020, 10, 685. [Google Scholar] [CrossRef]
  56. Keefe, F.J.; Brown, G.K.; Wallston, K.A.; Caldwell, D.S. Coping with rheumatoid arthritis pain: Catastrophizing as a maladaptive strategy. Pain 1989, 37, 51–56. [Google Scholar] [CrossRef]
  57. Ramírez-Maestre, C.; de la Vega, R.; Sturgeon, J.A.; Peters, M. Editorial: Resilience Resources in Chronic Pain Patients: The Path to Adaptation. Front. Psychol. 2019, 10, 2848. [Google Scholar] [CrossRef]
  58. Sturgeon, J.A.; Zautra, A.J. Resilience: A New Paradigm for Adaptation to Chronic Pain. Curr. Pain Headache Rep. 2010, 14, 105–112. [Google Scholar] [CrossRef]
  59. Sturgeon, J.A.; Zautra, A.J. Psychological Resilience, Pain Catastrophizing, and Positive Emotions: Perspectives on Comprehensive Modeling of Individual Pain Adaptation. Curr. Pain Headache Rep. 2013, 17, 1–9. [Google Scholar] [CrossRef]
  60. Kanzler, K.E.; Pugh, J.A.; McGeary, D.D.; Hale, W.J.; Mathias, C.W.; Kilpela, L.S.; Karns-Wright, T.E.; Robinson, P.J.; Dixon, S.A.; Bryan, C.J.; et al. Mitigating the Effect of Pain Severity on Activity and Disability in Patients with Chronic Pain: The Crucial Context of Acceptance. Pain Med. 2019, 20, 1509–1518. [Google Scholar] [CrossRef]
  61. DiBenedetto, D.; Wawrzyniak, K.M.; Finkelman, M.; Kulich, R.J.; Chen, L.; Schatman, M.E.; Stone, M.T.; Mao, J. Relationships between Opioid Dosing, Pain Severity, and Disability in a Community-Based Chronic Pain Population: An Exploratory Retrospective Analysis. Pain Med. 2019, 20, 2155–2165. [Google Scholar] [CrossRef]
  62. Craner, J.R.; Sperry, J.A.; Koball, A.M.; Morrison, E.J.; Gilliam, W.P. Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation. Int. J. Behav. Med. 2017, 24, 542–551. [Google Scholar] [CrossRef] [PubMed]
  63. Yu, L.; Kioskli, K.; McCracken, L.M. The Psychological Functioning in the COVID-19 Pandemic and Its Association with Psychological Flexibility and Broader Functioning in People With Chronic Pain. J. Pain 2021, 22, 926–939. [Google Scholar] [CrossRef] [PubMed]
  64. Suso-Ribera, C.; Camacho-Guerrero, L.; Osma, J.; Suso-Vergara, S.; Gallardo-Pujol, D. A Reduction in Pain Intensity Is More Strongly Associated with Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients. Front. Psychol. 2019, 10, 907. [Google Scholar] [CrossRef]
  65. Ferreira-Valente, M.A.; Pais-Ribeiro, J.; Jensen, M.P. Associations Between Psychosocial Factors and Pain Intensity, Physical Functioning, and Psychological Functioning in Patients with Chronic Pain. Clin. J. Pain 2014, 30, 713–723. [Google Scholar] [CrossRef] [PubMed]
  66. Goesling, J.; Henry, M.J.; Moser, S.E.; Rastogi, M.; Hassett, A.L.; Clauw, D.J.; Brummett, C. Symptoms of Depression Are Associated with Opioid Use Regardless of Pain Severity and Physical Functioning among Treatment-Seeking Patients with Chronic Pain. J. Pain 2015, 16, 844–851. [Google Scholar] [CrossRef]
  67. Matos, M.; Bernardes, S.; Goubert, L. The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: The mediating role of self-reported physical functioning. J. Behav. Med. 2016, 39, 704–715. [Google Scholar] [CrossRef] [PubMed]
  68. Jensen, M.P.; Nielson, W.R.; Turner, J.A.; Romano, J.M.; Hill, M.L. Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain. Pain 2003, 104, 529–537. [Google Scholar] [CrossRef]
  69. Karasawa, Y.; Yamada, K.; Iseki, M.; Yamaguchi, M.; Murakami, Y.; Tamagawa, T.; Kadowaki, F.; Hamaoka, S.; Ishii, T.; Kawai, A.; et al. Association between change in self-efficacy and reduction in disability among patients with chronic pain. PLoS ONE 2019, 14, e0215404. [Google Scholar] [CrossRef]
  70. Terwee, C.B.; van der Slikke, R.; van Lummel, R.C.; Benink, R.J.; Meijers, W.G.; de Vet, H.C. Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. J. Clin. Epidemiol. 2006, 59, 724–731. [Google Scholar] [CrossRef]
  71. Greenberg, J.; Mace, R.A.; Popok, P.J.; Kulich, R.J.; Patel, K.V.; Burns, J.W.; Somers, T.J.; Keefe, F.J.; Schatman, M.E.; Vrancenanu, A.-M. Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain. J. Pain Res. 2020, 13, 2255–2265. [Google Scholar] [CrossRef]
  72. World Health Organization. World Report on Disability; World Health Organization: Geneva, Switzerland, 2011. [Google Scholar]
  73. Taylor, A.M.; Phillips, K.; Patel, K.V.; Turk, D.C.; Dworkin, R.H.; Beaton, D.; Clauw, D.J.; Gignac, M.A.M.; Markman, J.D.; Williams, D.A.; et al. Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations. Pain 2016, 157, 1836. [Google Scholar] [CrossRef]
  74. Suso-Ribera, C.; Borba, V.M.; Martín-Brufau, R.; Suso-Vergara, S.; García-Palacios, A. Individual differences and health in chronic pain: Are sex-differences relevant? Health Qual. Life Outcomes 2019, 17, 128. [Google Scholar] [CrossRef] [PubMed]
  75. Estévez-López, F.; Álvarez-Gallardo, I.C.; Segura-Jiménez, V.; Soriano-Maldonado, A.; Borges-Cosic, M.; Pulido-Martos, M.; Aparicio, V.A.; Carbonell-Baeza, A.; Delgado-Fernández, M.; Geenen, R. The discordance between subjectively and objectively measured physical function in women with fibromyalgia: Association with catastrophizing and self-efficacy cognitions. The al-Ándalus project. Disabil. Rehabil. 2018, 40, 329–337. [Google Scholar] [CrossRef] [PubMed]
  76. Ramírez-Maestre, C.; Esteve, R.; López-Martínez, A.E. Fear-Avoidance, Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain. Ann. Behav. Med. 2014, 48, 402–410. [Google Scholar] [CrossRef] [PubMed]
  77. Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A.-G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav. Res. Methods 2009, 41, 1149–1160. [Google Scholar] [CrossRef]
  78. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.-A.; Goldenberg, D.L.; Häuser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [Google Scholar] [CrossRef]
  79. Wolfe, F. Fibromyalgia Research Criteria. J. Rheumatol. 2014, 41, 187. [Google Scholar] [CrossRef]
  80. Carrillo-De-La-Peña, M.T.; Triñanes, Y.; González-Villar, A.J.; Romero-Yuste, S.; Gomez-Perretta, C.; Arias, M.; Wolfe, F. Convergence between the 1990 and 2010 ACR diagnostic criteria and validation of the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ). Rheumatol. Int. 2014, 35, 141–151. [Google Scholar] [CrossRef]
  81. Ritter, P.L.; González, V.M.; Laurent, D.D.; Lorig, K.R. Measurement of pain using the visual numeric scale. J. Rheumatol. 2006, 33, 574–580. [Google Scholar]
  82. Breivik, H.; Borchgrevink, P.C.; Allen, S.M.; Rosseland, L.A.; Romundstad, L.; Hals, E.K.B.; Kvarstein, G.; Stubhaug, A. Assessment of pain. Br. J. Anaesth. 2008, 101, 17–24. [Google Scholar] [CrossRef]
  83. Sullivan, M.J.L.; Bishop, S.R.; Pivik, J. The Pain Catastrophizing Scale: Development and validation. Psychol. Assess. 1995, 7, 524–532. [Google Scholar] [CrossRef]
  84. Monticone, M.; Baiardi, P.; Ferrari, S.; Foti, C.; Mugnai, R.; Pillastrini, P.; Rocca, B.; Vanti, C. Development of the Italian version of the Pain Catastrophising Scale (PCS-I): Cross-cultural adaptation, factor analysis, reliability, validity and sensitivity to change. Spine 2012, 35, 1241–1246. [Google Scholar] [CrossRef] [PubMed]
  85. Vowles, K.E.; McCracken, L.M. Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. J. Consult. Clin. Psychol. 2008, 76, 397–407. [Google Scholar] [CrossRef]
  86. McCracken, L.M.; Yang, S.-Y. The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain 2006, 123, 137–145. [Google Scholar] [CrossRef]
  87. McCracken, L.M.; Vowles, K.; Eccleston, C. Acceptance of chronic pain: Component analysis and a revised assessment method. Pain 2004, 107, 159–166. [Google Scholar] [CrossRef] [PubMed]
  88. Bernini, O.; Pennato, T.; Cosci, F.; Berrocal, C. The Psychometric Properties of the Chronic Pain Acceptance Questionnaire in Italian Patients with Chronic Pain. J. Health Psychol. 2010, 15, 1236–1245. [Google Scholar] [CrossRef]
  89. Ayán, C.; Martín, V.; Alonso-Cortés, B.; Álvarez, M.; Valencia, M.; Barrientos, M. Relationship between aerobic fitness and quality of life in female fibromyalgia patients. Clin. Rehabil. 2007, 21, 1109–1113. [Google Scholar] [CrossRef] [PubMed]
  90. Carbonell-Baeza, A.; Ruiz, J.; Aparicio, V.A.; Ortega, F.B.; Delgado-Fernández, M. The 6-Minute Walk Test in Female Fibromyalgia Patients: Relationship with Tenderness, Symptomatology, Quality of Life, and Coping Strategies. Pain Manag. Nurs. 2013, 14, 193–199. [Google Scholar] [CrossRef] [PubMed]
  91. Carbonell-Baeza, A.; Aparicio, V.A.; Ortega, F.B.; Cuevas, A.M.; Alvarez, I.C.; Ruiz, J.R.; Delgado-Fernandez, M. Does a 3-month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia? Br. J. Sports Med. 2011, 45, 1189–1195. [Google Scholar] [CrossRef]
  92. Pankoff, B.; Overend, T.; Lucy, D.; White, K. Validity and responsiveness of the 6-minute walk test for people with fibromyalgia. J. Rheumatol. 2000, 27, 2666–2670. [Google Scholar]
  93. Larsson, U.E.; Reynisdottir, S. The six-minute walk test in outpatients with obesity: Reproducibility and known group validity. Physiother. Res. Int. 2008, 13, 84–93. [Google Scholar] [CrossRef] [PubMed]
  94. Mattsson, E.; Larsson, U.E.; Rössner, S. Is walking for exercise too exhausting for obese women? Int. J. Obes. 1997, 21, 380–386. [Google Scholar] [CrossRef] [PubMed]
  95. De Souza, S.A.F.; Faintuch, J.; Fabris, S.M.; Nampo, F.K.; Luz, C.; Fabio, T.L.; Sitta, I.S.; Fonseca, I.C.D.B. Six-minute walk test: Functional capacity of severely obese before and after bariatric surgery. Surg. Obes. Relat. Dis. 2009, 5, 540–543. [Google Scholar] [CrossRef] [PubMed]
  96. WHO. World Health Organization Technical Report Series Obesity: Preventing and Managing the Global Epidemic; Report of a WHO Consultation on Obesity; WHO: Geneva, Switzerland, 2000; ISBN 9241208945. [Google Scholar]
  97. Hunter, J. Demographic Variables and Chronic Pain. Clin. J. Pain 2001, 17, S14–S19. [Google Scholar] [CrossRef]
  98. Ferrari, S.; Vanti, C.; Pellizzer, M.; Dozza, L.; Monticone, M.; Pillastrini, P. Is there a relationship between self-efficacy, disability, pain and sociodemographic characteristics in chronic low back pain? A multicenter retrospective analysis. Arch. Physiother. 2019, 9, 1–9. [Google Scholar] [CrossRef]
  99. Fillingim, R.B.; Doleys, D.M.; Edwards, R.R.; Lowery, D. Clinical Characteristics of Chronic Back Pain as a Function of Gender and Oral Opioid Use. Spine 2003, 28, 143–150. [Google Scholar] [CrossRef] [PubMed]
  100. Rijken, M.; Spreeuwenberg, P.; Schippers, J.; Groenewegen, P.P. The importance of illness duration, age at diagnosis and the year of diagnosis for labour participation chances of people with chronic illness: Results of a nationwide panel-study in the Netherlands. BMC Public Health 2013, 13, 803. [Google Scholar] [CrossRef]
  101. Chaney, J.M.; Uretsky, D.L.; Mullins, L.L.; Doppler, M.J.; Palmer, W.R.; Wees, S.J.; Klein, H.S.; Doud, D.K.; Reiss, M.L. Differential effects of age and illness duration on pain-depression and disability-depression relationships in rheumatoid arthritis. Int. J. Rehabil. Health 1996, 2, 101–112. [Google Scholar] [CrossRef]
  102. Carbonell-Baeza, A.; Aparicio, V.A.; Sjöström, M.; Ruiz, J.R.; Delgado-Fernandez, M. Pain and functional capacity in female fibromyalgia patients. Pain Med. 2011, 12, 1667–1675. [Google Scholar] [CrossRef] [PubMed]
  103. Jamovi (Version 1.2) The Jamovi Project 2020. Available online: https://www.jamovi.org/about.html (accessed on 16 August 2021).
  104. Ramírez-Maestre, C.; Esteve, R.; Ruiz-Párraga, G.; Gómez-Pérez, L.; López-Martínez, A.E. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain. Int. J. Behav. Med. 2017, 24, 239–248. [Google Scholar] [CrossRef]
  105. Wertli, M.M.; Eugster, R.; Held, U.; Steurer, J.; Kofmehl, R.; Weiser, S. Catastrophizing—A prognostic factor for outcome in patients with low back pain: A systematic review. Spine J. 2014, 14, 2639–2657. [Google Scholar] [CrossRef]
  106. Ferreira-Valente, A.; Solé, E.; Sánchez-Rodríguez, E.; Sharma, S.; Pathak, A.; Jensen, M.P.; Miró, J.; de la Vega, R. Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals with Chronic Pain? Clin. J. Pain 2021, 37, 339–348. [Google Scholar] [CrossRef] [PubMed]
  107. Catala, P.; Suso-Ribera, C.; Gutierrez, L.; Perez, S.; Lopez-Roig, S.; Peñacoba, C. Is thought management a resource for functioning in women with fibromyalgia irrespective of pain levels? Pain Med. 2021, 22, 1827–1836. [Google Scholar] [CrossRef]
  108. Tangen, S.F.; Helvik, A.-S.; Eide, H.; Fors, E.A. Pain acceptance and its impact on function and symptoms in fibromyalgia. Scand. J. Pain 2020, 20, 727–736. [Google Scholar] [CrossRef]
  109. Rodero, B.; Casanueva, B.; Luciano, J.V.; Gili, M.; Serrano-Blanco, A.; García-Campayo, J. Relationship between behavioural coping strategies and acceptance in patients with fibromyalgia syndrome: Elucidating targets of interventions. BMC Musculoskelet. Disord. 2011, 12, 143. [Google Scholar] [CrossRef]
  110. Trainor, H.; Baranoff, J.; Henke, M.; Winefield, H. Functioning with fibromyalgia: The role of psychological flexibility and general psychological acceptance. Aust. Psychol. 2019, 54, 214–224. [Google Scholar] [CrossRef]
  111. Gracely, R.H.; Geisser, M.E.; Giesecke, T.; Grant, M.A.B.; Petzke, F.; Williams, D.A.; Clauw, D.J. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain 2004, 127, 835–843. [Google Scholar] [CrossRef]
  112. Roelofs, J.; Peters, M.L.; McCracken, L.; Vlaeyen, J. The pain vigilance and awareness questionnaire (PVAQ): Further psychometric evaluation in fibromyalgia and other chronic pain syndromes. Pain 2003, 101, 299–306. [Google Scholar] [CrossRef]
  113. Cooper, L.; Ells, L.; Ryan, C.; Martin, D. Perceptions of adults with overweight/obesity and chronic musculoskeletal pain: An interpretative phenomenological analysis. J. Clin. Nurs. 2018, 27, e776–e786. [Google Scholar] [CrossRef] [PubMed]
  114. Hulens, M.; Vansant, G.; Claessens, A.L.; Lysens, R.; Muls, E. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand. J. Med. Sci. Sports 2003, 13, 98–105. [Google Scholar] [CrossRef] [PubMed]
  115. Neumann, L.; Lerner, E.; Glazer, Y.; Bolotin, A.; Shefer, A.; Buskila, D. A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin. Rheumatol. 2008, 27, 1543–1547. [Google Scholar] [CrossRef] [PubMed]
  116. Yunus, M.B.; Arslan, S.; Aldag, J.C. Relationship between body mass index and fibromyalgia features. Scand. J. Rheumatol. 2002, 31, 27–31. [Google Scholar] [CrossRef] [PubMed]
  117. Urquhart, D.M.; Berry, P.; Wluka, A.; Strauss, B.J.; Wang, Y.; Proietto, J.; Jones, G.; Dixon, J.B.; Cicuttini, F.M. Increased Fat Mass Is Associated with High Levels of Low Back Pain Intensity and Disability. Spine 2011, 36, 1320–1325. [Google Scholar] [CrossRef]
  118. Han, T.; Schouten, J.S.; Lean, M.; Seidell, J. The prevalence of low back pain and associations with body fatness, fat distribution and height. Int. J. Obes. 1997, 21, 600–607. [Google Scholar] [CrossRef]
  119. Donnelly, J.E.; Smith, B.; Jacobsen, D.J.; Kirk, E.; DuBose, K.; Hyder, M.; Bailey, B.; Washburn, R. The role of exercise for weight loss and maintenance. Best Pract. Res. Clin. Gastroenterol. 2004, 18, 1009–1029. [Google Scholar] [CrossRef]
  120. Egger, G.; Dixon, J. Non-nutrient causes of low-grade, systemic inflammation: Support for a ‘canary in the mineshaft’ view of obesity in chronic disease. Obes. Rev. 2010, 12, 339–345. [Google Scholar] [CrossRef]
  121. Attridge, N.; Noonan, D.; Eccleston, C.; Keogh, E. The disruptive effects of pain on n-back task performance in a large general population sample. Pain 2015, 156, 1885–1891. [Google Scholar] [CrossRef]
  122. Hodges, P.; Smeets, R. Interaction Between Pain, Movement, and Physical Activity: Short-term benefits, long-term consequences, and targets for treatment. Clin. J. Pain 2015, 31, 97–107. [Google Scholar] [CrossRef]
  123. Celletti, C.; Castori, M.; La Torre, G.; Camerota, F. Evaluation of Kinesiophobia and Its Correlations with Pain and Fatigue in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type. BioMed Res. Int. 2013, 2013, 1–7. [Google Scholar] [CrossRef]
  124. Busch, A.J.; Barber, K.A.; Overend, T.J.; Peloso, P.M.J.; Schachter, C.L. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst. Rev. 2007, 17, CD003786. [Google Scholar] [CrossRef] [PubMed]
  125. Fontaine, K.R.; Conn, L.; Clauw, D.J. Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: Results of a randomized trial. Arthritis Res. Ther. 2010, 12, R55. [Google Scholar] [CrossRef]
  126. Macfarlane, G.J.; Kronisch, C.; Dean, L.; Atzeni, F.; Häuser, W.; Flüß, E.; Choy, E.; Kosek, E.; Amris, K.; Branco, J.; et al. EULAR revised recommendations for the management of fibromyalgia. Ann. Rheum. Dis. 2016, 76, 318–328. [Google Scholar] [CrossRef] [PubMed]
  127. Da Costa, D.; Abrahamowicz, M.; Lowensteyn, I.; Bernatsky, S.; Dritsa, M.; Fitzcharles, M.-A.; Dobkin, P.L. A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia. Rheumatology 2005, 44, 1422–1427. [Google Scholar] [CrossRef] [PubMed]
  128. Meiworm, L.; Jakob, E.; Walker, U.A.; Peter, H.H.; Keul, J. Patients with fibromyalgia benefit from aerobic endurance exercise. Clin. Rheumatol. 2000, 19, 253–257. [Google Scholar] [CrossRef]
  129. Rooks, D.S.; Silverman, C.B.; Kantrowitz, F.G. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: A pilot study. Arthritis Care Res. 2002, 47, 22–28. [Google Scholar] [CrossRef] [PubMed]
  130. Petridou, A.; Siopi, A.; Mougios, V. Exercise in the management of obesity. Metabolism 2018, 92, 163–169. [Google Scholar] [CrossRef]
  131. Oppert, J.-M.; Bellicha, A.; Ciangura, C. Physical activity in management of persons with obesity. Eur. J. Intern. Med. 2021, 20, S0953–S6205. [Google Scholar] [CrossRef]
  132. Johns, D.J.; Hartmann-Boyce, J.; Jebb, S.A.; Aveyard, P. Diet or Exercise Interventions vs Combined Behavioral Weight Management Programs: A Systematic Review and Meta-Analysis of Direct Comparisons. J. Acad. Nutr. Diet. 2014, 114, 1557–1568. [Google Scholar] [CrossRef]
  133. Alamam, D.M.; Leaver, A.; Alsobayel, H.I.; Moloney, N.; Lin, J.; Mackey, M.G. Low Back Pain–Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non–English-Speaking Populations: Systematic Review and Meta-Analysis. Pain Med. 2021. [Google Scholar] [CrossRef]
  134. Williams, D.A.; Gendreau, M.; Hufford, M.R.; Groner, K.; Gracely, R.H.; Clauw, D.J. Pain Assessment in Patients with Fibromyalgia Syndrome: A consideration of methods for clinical trials. Clin. J. Pain 2004, 20, 348–356. [Google Scholar] [CrossRef] [PubMed]
  135. Clauw, D.J.; Crofford, L.J. Chronic widespread pain and fibromyalgia: What we know, and what we need to know. Best Pract. Res. Clin. Rheumatol. 2003, 17, 685–701. [Google Scholar] [CrossRef]
  136. Harris, R.E.; Williams, D.A.; McLean, S.; Sen, A.; Hufford, M.; Gendreau, R.M.; Gracely, R.H.; Clauw, D.J. Characterization and consequences of pain variability in individuals with fibromyalgia. Arthritis Rheum. 2005, 52, 3670–3674. [Google Scholar] [CrossRef] [PubMed]
Table 1. Means and standard deviations of sociodemographic characteristics and clinical measures. The theoretical range and actual range are reported. n = 160.
Table 1. Means and standard deviations of sociodemographic characteristics and clinical measures. The theoretical range and actual range are reported. n = 160.
Sociodemographic Characteristics n = 160
Age in years (mean ± SD) 43.6 ± 7.25
Body mass index (mean ± SD) 44.3 ± 7.15
Pain duration in years (mean ± SD) 7.08 ± 2.70
Current opioid use (%) 13.1%
Employed (%) 71.9%
Full-time 22.5%
Part-time 49.4%
Clinical measuresTheoretical rangeSample’s rangeMean ± SD
Widespread pain index0–197–1813.8 ± 2.70
Symptoms’ severity0–125–118.13 ± 1.85
Numeric pain rating scale0–103–95.67 ± 1.58
Pain catastrophizing scale0–520–4427.3 ± 10.3
Chronic pain acceptance questionnaire0–12021–7451.7 ± 11.2
Physical functioning subscale0–309–2917.7 ± 4.77
6-Min walking test in metersNA *201–402306 ± 59.4
Note. * NA: Not applicable.
Table 2. Pearson correlation coefficients between study variables. n = 160.
Table 2. Pearson correlation coefficients between study variables. n = 160.
1234
1. Pain severity (NPRS)-
2. Pain catastrophizing (PCS)0.42 *-
3. Pain acceptance (CPAQ)−0.39 *−0.49 *-
4. Self-reported physical functioning limitations (PF-FIQR)0.36 *0.43 *−0.47 *-
5. Performance-based physical functioning (6MWT)−0.38 *−0.57 *0.52 *−0.53 *
Note. NPRS: numeric pain rating scale; PCS: pain catastrophizing scale; CPAQ: chronic pain acceptance questionnaire; PF-FIQR: physical functioning subscale of the firbomyalgia impact questionnaire; 6MWT: 6-minute walking test. * p < 0.001.
Table 3. Multivariate hierarchical regression predicting self-report physical functioning limitations.
Table 3. Multivariate hierarchical regression predicting self-report physical functioning limitations.
Step 1Step 2Step 3
FactorsB (SE)pB (SE)pB (SE)p
Pain duration−0.04 (0.14)0.7920.02 (0.13)856−0.07 (0.12)0.566
Age−0.01 (0.05)0.8260.02 (0.05)0.707−0.01(0.04)0.929
Current opioid use2.86 (1.13)0.0122.70 (1.06)0.1102.66 (0.95)0.006
Body mass index0.01 (0.05)0.897−0.04 (0.05)0.400−0.09 (0.23)0.054
Pain severity 1.09 (0.23)<0.0010.44 (0.23)0.060
Pain catastrophizing 0.12 (0.04)0.003
Pain acceptance −0.13 (0.03)<0.001
Table 4. Multivariate hierarchical regression predicting performance-based physical functioning.
Table 4. Multivariate hierarchical regression predicting performance-based physical functioning.
Step 1Step 2Step 3
FactorsB (SE)pB (SE)pB (SE)p
Pain duration−3.85 (1.66)0.022−4.65 (1.54)0.003−3.37 (1.30)0.010
Age−1.07 (0.62)0.089−1.16 (0.58)0.045−0.81 (0.49)0.099
Current opioid use−37.79 (13.47)0.006−35.68 (0.59)0.005−35.99 (10.43)<0.001
Body mass index−1.02 (0.63)0.109−0.36 (0.59)0.5440.29 (0.51)0.574
Pain severity −14.46 (2.69)<0.001−5.05 (2.54)0.048
Pain catastrophizing −2.21 (0.43)<0.001
Pain acceptance 1.45 (0.37)<0.001
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Varallo, G.; Scarpina, F.; Giusti, E.M.; Suso-Ribera, C.; Cattivelli, R.; Guerrini Usubini, A.; Capodaglio, P.; Castelnuovo, G. The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. J. Pers. Med. 2021, 11, 810. https://doi.org/10.3390/jpm11080810

AMA Style

Varallo G, Scarpina F, Giusti EM, Suso-Ribera C, Cattivelli R, Guerrini Usubini A, Capodaglio P, Castelnuovo G. The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. Journal of Personalized Medicine. 2021; 11(8):810. https://doi.org/10.3390/jpm11080810

Chicago/Turabian Style

Varallo, Giorgia, Federica Scarpina, Emanuele Maria Giusti, Carlos Suso-Ribera, Roberto Cattivelli, Anna Guerrini Usubini, Paolo Capodaglio, and Gianluca Castelnuovo. 2021. "The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity" Journal of Personalized Medicine 11, no. 8: 810. https://doi.org/10.3390/jpm11080810

APA Style

Varallo, G., Scarpina, F., Giusti, E. M., Suso-Ribera, C., Cattivelli, R., Guerrini Usubini, A., Capodaglio, P., & Castelnuovo, G. (2021). The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. Journal of Personalized Medicine, 11(8), 810. https://doi.org/10.3390/jpm11080810

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop