The impact of goal cognition and pain severity on disability and depression in adults with chronic pain: An examination of direct effects and mediated effects via pain-induced fear

A group of 100 adults with chronic low back pain (CLBP), drawn from a larger national sample, completed a questionnaire battery that assessed (among other things) goal conflict and goal self-efficacy, pain severity, pain-induced fear, and 3 months later, two important clinical outcomes: physical disability and depression. Consistent with emerging motivation-centered models of adaptation (e.g., Ford, Humans as self-constructing living systems: A developmental perspective on behavior and personality. Erlbaum, 1987; Karoly Review of General Psychology, 3, 264-291, 1999) and cognitive-behavioral accounts of pain-specific fears (e.g., Asmundson et al. Clinical Psychology Review, 19, 97-119, 1999), structural equation analyses revealed that (a) goal self-efficacy, goal conflict, and pain severity independently predicted pain-induced fear, (b) pain-induced fear fully mediated the effects of goal conflict and goal self-efficacy on physical disability and depression, and (c) pain-induced fear partially mediated the effects of severity on disability and depression. Results suggest that clinical pain specialists should treat pain-induced fear as a means of forestalling disability and depression, and that they should also seek to modify how CLBP patients think about and organize their life goals.