The Relationship Between Approach to Activity Engagement, Specific Aspects of Physical Function, and Pain Duration in Chronic Pain.

OBJECTIVES To examine: (1) the relationships between habitual approach to activity engagement and specific aspects of physical functioning in chronic pain; and (2) whether or not these relationships differ according to pain duration. MATERIALS AND METHODS Outpatients (N=169) with generalized chronic pain completed a set of written questionnaires. Categories of "approach to activity engagement" were created using the confronting and avoidance subscales of the Pain and Activity Relations Questionnaire. An interaction term between "approach to activity engagement" categories and pain duration was entered into analysis with age, sex, pain intensity, the categorical "approach to activity engagement" variable, and pain duration, in 9 ordinal regression models investigating functioning in a variety of daily activities. RESULTS The "approach to activity engagement" category predicted the personal care, lifting, sleeping, social life, and traveling aspects of physical functioning but, interestingly, not the performance skills used during these activities, that is, walking, sitting, and standing. The interaction term was significant in 2 models; however, the effect of pain duration on associations was the inverse of that theorized, with the relationship between variables becoming less pronounced with increasing duration of pain. DISCUSSION The results of this study do not support the commonly held notion that avoidance and/or overactivity behavior leads to deconditioning and reduced physical capacity over time. Findings do, however, suggest that a relationship exists between avoidance and/or overactivity behavior and reduced participation in activities. Implications for the clinical management of chronic pain and directions for further research are discussed.