![]() Partial Least Squares Structural Equation Modelling (PLS-SEM) is a non-parametric method that can be applied to model and estimate complex relationships (paths) among multiple dependent and independent variables ( 46). The combination of both pain and depression is associated with poorer treatment outcomes than either condition alone ( 44, 45), which may indicate that psychological distress is a moderating factor. Presence of moderating variables indicate cohort heterogeneity. There is a knowledge gap of the relative importance of pain intensity and psychological distress for aspects of life impact such as interference and life control in real life practise settings. ![]() For example, pain intensity may act both via direct and indirect (mediating) effects on aspects of life impact. The holistic biopsychosocial model considers complex relationships between the different facets of living with chronic pain. Social support can help patients cope with and distract from negative life events and manage pain and its impacts ( 41– 43). Social support is defined as the resources received and perceived as being available from others in one's social network ( 41). In addition to traditional outcomes such as pain, psychological distress, interference and function, also social outcomes have been advocated as important ( 40). Differentiated associations for pain intensity and mood variables in relation to impact aspects have also been reported in tension-type headache ( 39). However, for life control aspects, anxiety and depression had stronger relationships than pain intensity ( 24). Also, in the network study, pain intensity, depression, and anxiety showed strong associations with pain interference ( 24). Thus, there is an incomplete understanding of what variables determine these aspects. However, only 43%–53% of the variations in these two life impact variables were accounted for. Pain intensity was somewhat more important for interference than depressive symptoms, whereas life control was more strongly associated with symptoms of anxiety and depression ( 38). For example, a mix of variables (pain intensity, emotion variables, fear, etc.) influence life impact variables such as life control and interference as previously reported from SQRP ( 35– 38). Thus, pain and psychological distress are associated with interference in daily life and perceived lack of life control ( 11, 35). A network analysis of another SQRP cohort ( N = 2,241) confirmed weak correlations between pain intensity and the two mood variables ( 24).īoth chronic pain and depressive and anxiety symptoms are associated with different negative impacts on daily living and functioning, treatment responses, and health costs ( 15, 25– 34). depressive symptoms of HAD: R 2 = 0.07–0.11 pain intensity vs. According to a large SQRP study ( N > 35,000 chronic pain patients), the levels of pain intensity and mood aspects were significantly correlated but with relatively low explained variances ( R 2) (pain intensity variables vs. Complex bidirectional relationships between pain and mood exist according to cross-sectional and longitudinal studies, but these and other studies posit different theories to explain these relationships ( 13, 15– 23). Some studies report higher prevalence for depression, which can be due to methods applied and societal factors ( 13, 14). Data from the Swedish Quality Registry for Pain Rehabilitation (SQRP) covering specialist care for chronic pain patients indicated that 39.5% of the cohort fulfilled the criteria for a highly probable anxiety case according to Hospital Anxiety and Depression Scale (HADS) the corresponding figure for depressive symptoms was 35.2% ( 12). ![]() Hence, modern clinical practice uses a biopsychosocial framework when assessing patients and designing and performing interventions ( 10, 11).ĭepression and anxiety are common co-morbidities in chronic pain. Pain is a complex interaction of biological, psychological, social, and contextual factors ( 7– 9). Chronic pain conditions are associated with increased risks for intense and disturbing pain, psychological distress, disability, poor health, and low quality of life ( 1– 6).
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