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Kinesiophobia and Work Disability in Fibromyalgia: Cognitive Mediation in a Population-Based Study of Women
Giordano Mayer De Freitas1, Guilherme Teixeira Lopes1, Graziele Borges Bueno1,2
1Laboratory of Pain and Neuromodulation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil.
Background:
Work disability in fibromyalgia is only partially explained by symptom severity, suggesting a relevant contribution of cognitive-behavioral mechanisms.
Objective:
This study aimed to determine whether kinesiophobia is associated with fibromyalgia impact and work-related disability and to assess whether pain catastrophizing mediates these relationships within a hierarchical biopsychosocial framework.
Methods:
This cross-sectional study included 2096 women with fibromyalgia recruited through a nationwide online survey. Participants completed validated instruments assessing fibromyalgia impact (FIQ), pain catastrophizing (PCS), depressive symptoms (PHQ-9), central sensitization (CSI), and kinesiophobia (Tampa Scale). Pain-related work disability was defined using the Graded Chronic Pain Scale-Revised (GCPS-R). Hierarchical logistic regression models identified factors independently associated with work disability. Mediation was tested using bootstrapped analyses (5000 resamples).
Results:
Kinesiophobia demonstrated a robust independent association with work disability (OR 1.03; 95% CI 1.02-1.05) after adjustment for sociodemographic factors, clinical pain phenotype, systemic burden, pain severity, psychocognitive load, and medication burden. Other relevant contributors included pain severity (OR 1.96; 95% CI 1.70-2.27), psychocognitive burden (OR 1.35; 95% CI 1.15-1.58), use of benzodiazepines (OR 1.74; 95% CI 1.33-2.28), and opioid use (OR 1.29; 95% CI 1.06-1.56). Mediation analysis indicated a significant indirect effect of kinesiophobia on work disability through pain catastrophizing (β = 0.131; 95% CI 0.078-0.188).
Conclusions:
Kinesiophobia is a proximal determinant of work disability in fibromyalgia, exerting direct and cognitively mediated effects through pain catastrophizing, reinforcing the fear-avoidance framework and the need for psychologically informed rehabilitation.
