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

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 (PC), growing evidence suggests that pain self-efficacy (PSE) 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.

A total of 259 patients with chronic pain (154 with HICP; 105 without HICP) completed validated measures at baseline and 3 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 (ie, pain interference, physical function, fatigue, and sleep disturbance) and psychosocial health (ie, depression, anxiety, anger, and social isolation).

Repeated measures MANOVA showed a significant group effect (HICP vs. No-HICP), but no significant time or group by time interaction. 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 to 0.445). PSE explained a greater proportion of group differences in health outcomes (52.9% to 71.7%) compared with PC (10.1% to 43.3%). Especially, SE in activity engagement accounted for the largest health disparities between the groups.

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