Acceptance and patient functioning in chronic pain: the mediating role of physical activity

Activity engagement, which refers to pursuing activities despite pain, is conceptually related to pain acceptance. A recent diary study suggested that pain acceptance precedes and directly influences physical activity, and thus, pain acceptance appears to be an important aspect of eliciting better functioning by allowing patients with chronic pain (PCPs) to participate in physical activity despite the pain. This retrospective, cross-sectional cohort study was conducted to investigate the mediating effect of physical activity on the association between pain acceptance and functioning and the association between physical activity level and functioning in PCPs.

The study participants were 176 patients seeking treatment for chronic pain at a tertiary pain center in Korea. The Chronic Pain Acceptance Questionnaire, International Physical Activity Questionnaire-Short Form, and Short Form-36 were used to assess pain acceptance, physical activity, and patient functioning. The mediating effects of physical activity were tested using procedures described by Baron and Kenny. Also, three hierarchical multiple linear regression analyses were conducted to identify levels of physical activity that predict measures of patient functioning.

Physical activity partially mediated the association between pain acceptance and patient functioning except for pain intensity. Furthermore, walking and moderate activity were found to be associated with improvements in all areas of patient functioning except for pain intensity.

To improve the functioning of PCPs, health professionals may need to help patients accept private experiences related to pain and plan activity pacing programs that focus on value-based activities.