Important determinants of self-efficacy in patients with chronic musculoskeletal pain

To define the presenting characteristics of a population of patients with chronic musculoskeletal pain seen in a tertiary rheumatology clinic, and to investigate which factors are associated with self-efficacy in these patients.

Data were collected prospectively for 196 patients who attended the clinic for the first time between October 2000 and August 2002. The primary outcome measure was self-efficacy, measured using the Pain Self-Efficacy Questionnaire. Secondary outcome measures were pain intensity and disability due to pain. The data were analyzed using both univariate and multiple regression methods.

These patients had typically undergone extensive investigations and tried various therapies but were left with persisting pain and poor self-efficacy. Multiple regression analysis showed that after adjustment for other factors, the presence of depressive symptoms and employment status were associated with self-efficacy. Patients who reported depressive symptoms had mean self-efficacy scores 7.0 units lower (95% confidence interval, CI: 2.2-11.9) than those who did not. Being employed was associated with higher self-efficacy. The retired had scores 8.3 units lower than employed people (95% CI: 2.4-14.2), whereas housewives and the unemployed had scores approximately 14 units lower (95% CI: 8.0-20.9 and 7.5-19.0, respectively) than employed people. There was also some evidence that distribution of painful sites was associated with self-efficacy. Patients with extensive pain had scores 4.1 units (95% CI: -0.4-8.6) lower than those with limited pain.

Depressive symptoms, occupational status, and possibly distribution of pain are associated with the reported confidence of these patients with chronic pain in their ability to carry out everyday activities. Possible links to the idea of legitimacy of pain are discussed.