Thread by @CorKinetic

Pain self efficacy (PSE)

PSE is the ability to function WITH or DESPITE some pain. This could be work, social or family related.

PSE is not a magic bullet, but might be part of recovery for some, or even many!

Here is a 🧵

"Pain self-efficacy refers to one's confidence regarding one's ability to function effectively while in pain"

pubmed.ncbi.nlm.nih.gov/16446108/

Why do we need it?

Pain is a normal part of the human experience. It cannot always be fixed or avoided. Even if pain relief is the goal, pain is rarely abolished in one visit...

Here are 3 reasons....

1️⃣Treatment efficacy
2️⃣Natural history
3️⃣Persisting pain

1️⃣ - Treatment efficacy

Treatments currently for pain are not that great if we are being honest, so pain disrupting life less is probably a good thing!

For that a bit of PSE is helpful

2️⃣ - Natural history

Think conditions that last months and maybe up to years even with treatment. Not having any pain is unlikely so having some PSE is likely to help along the way and reduce the disruption of pain on life

3️⃣ - Persisting pain

A sub set of people with pain have had it for a long time, years and maybe even decades without much relief.

Again this means that PSE is likely a key variable

Here we see how PSE relates to pain intensity, although it could be argued this is the not the aim

"Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability"

bfpt.springeropen.com/articles/10.11…

Here we see PSE is implicated in the recovery from
back pain

ncbi.nlm.nih.gov/pmc/articles/P…

Here again we see PSE as a predictor of back pain rehab outcomes

ncbi.nlm.nih.gov/pmc/articles/P…

Here PSE is implicated in mediating disability

This is one of the key areas that PSE seems to implicated in

"Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain"

pubmed.ncbi.nlm.nih.gov/20655254/

And again....

Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients

sciencedirect.com/science/articl…

It also plays a role in function

"Are Changes in Fear-Avoidance Beliefs and Self-efficacy Mediators of Function and Pain at Discharge in Patients With Acute and Chronic Low Back Pain?"

pubmed.ncbi.nlm.nih.gov/31905094/

PSE has also been highlighted in recovery from shoulder pain, with high PSE playing a role

"Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain"

pubmed.ncbi.nlm.nih.gov/27445360/

Can you have too much PSE?

Definitely! This is not discussed as much, but the ability to keep going even though it hurts probably plays a role in overuse injuries from stress fractures to tendinopathies

How is it measured?

The pain self efficacy questionnaire is used A LOT in research

I prefer to discuss pain related beliefs in a more conversational way

novopsych.com.au/assessments/he…

Does healthcare/society reduce PSE?

I definitely think it does.

This can happen through over medicalisation, over diagnosis and over treatment.

The opioid crisis might be a great example of this with pain killers being prescribed for ANY pain

As previously stated, this is not a magic bullet for pain, but is probably helpful for most painful problems

We need some more interventional research targeting PSE rather than secondary measures and analysis

END