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Rheumatology Advance Access published online on October 3, 2008
Rheumatology, doi:10.1093/rheumatology/ken377
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Factors affecting self-efficacy and pain intensity in patients with chronic musculoskeletal pain seen in a specialist rheumatology pain clinic

A. Rahman1, E. Reed2, M. Underwood3, M. E. Shipley1 and R. Z. Omar2,4

1Centre for Rheumatology Research, Division of Medicine, 2Department of Statistical Science, University College London, London, 3Warwick Clinical Trials Unit, University of Warwick, Warwick and 4UCLH/UCL Biomedical Research Unit, London, UK.

Correspondence to: A. Rahman, Centre for Rheumatology Research, Room 331, Windeyer Institute, 46 Cleveland Street, London W1T 4JF, UK. E-mail: anisur.rahman{at}ucl.ac.uk


  Abstract

Objective. Chronic musculoskeletal pain is a very common and costly health problem. Patients presenting to rheumatology clinics with chronic pain can be difficult to manage. We studied 354 patients referred to a rheumatology chronic pain clinic over 5 yrs to identify factors affecting their self-efficacy and intensity of pain.

Methods. We collected data for each patient, covering demographic and psychosocial factors, characteristics of their pain and previous treatment. We measured self-efficacy using a validated questionnaire, and pain intensity (PI) on an NRS. We performed multiple regression analysis to determine as to which factors were independently associated with these outcomes.

Results. Despite extensive previous investigations and treatment, these patients had low self-efficacy [median = 26.5, interquartile range (IQR) 15–38, best possible = 60] and high PI scores (median = 7, worst possible = 10, IQR 5–9). Low self-efficacy was most clearly associated with depressive symptoms and not being employed. PI was most clearly associated with depressive symptoms, extensive pain and lower level of education.

Conclusion. Community-based studies suggest psychosocial factors are very important in determining outcomes in patients with chronic pain. This study suggests that the same is true in patients referred to rheumatologists due to chronic musculoskeletal pain and that these factors—particularly depressive symptoms and not being employed—are more important than site or duration of pain in those patients.

KEY WORDS: Chronic musculoskeletal pain, Self-efficacy, Pain clinic

Submitted 16 February 2008; revised version accepted 19 August 2008.
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