The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache.
Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors of pain-related functional outcomes in youth with chronic pain. Self-efficacy is a potential resiliency factor that can mitigate the influence that pain-related fear has on outcomes in youth with chronic pain. Drawing from theoretical assertions tested among adults with chronic pain, this study aimed to determine whether pain-related self-efficacy mediates the adverse influence of pain-related fear on functional outcomes in a sample of youth with chronic headache. In a cross-sectional design of 199 youth with headache, self-efficacy was strongly associated with fear, disability, school impairment, and depressive symptoms. Pain intensity and self-efficacy were only modestly related, indicating that level of pain has less influence on one's confidence functioning with pain. Self-efficacy partially mediated relationships between pain-related fear and both functional disability and school functioning but did not mediate the relationship between pain-related fear and depressive symptoms. These results suggest that confidence in the ability to function despite pain and fear avoidance each uniquely contributes to pain-related outcomes in youth with chronic headache. These results further suggest that treatment for chronic headache in youth must focus not only on decreasing pain-related fear but also on enhancing a patient's pain-related self-efficacy.


CONCLUSIONS
Pain-related self-efficacy is an important resiliency factor impacting the influence of pain-related fear on functional disability and school functioning in youth with headache. Enhancing self-efficacy may be a key mechanism for improving behavioral outcomes. Clinicians can reduce pain-related fear and enhance pain-related self-efficacy through interventions that encourage accomplishment and self-confidence.
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Elizabeth
E
Carpino
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Sharon
S
Segal
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts.
Deirdre
D
Logan
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts.
Alyssa
A
Lebel
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts. Electronic address: Laura.Simons@childrens.harvard.edu.
Laura E
LE
Simons
D000124:Achievement; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005239:Fear; D005260:Female; D020773:Headache Disorders / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012574:Schools; D020377:Self Efficacy; D012720:Severity of Illness Index
Pain-related self-efficacy; headache; mediation analysis; pain-related fear; youth