Pain Self-Efficacy as a Mediator between Fear-Avoidance Beliefs and Social Avoidance among Individuals with Comorbid Post- Traumatic Stress Disorder and Chronic Pain
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Post-traumatic stress disorder (PTSD) and chronic pain frequently coexist, contributing to functional disability and social isolation. Aim: This study investigated whether pain self-efficacy mediates the relationship between fear-avoidance beliefs and social avoidance in individuals with comorbid PTSD and chronic pain. Methods: A descriptive correlational design was implemented. A purposive sample of 84 patients with chronic pain and comorbid PTSD was recruited from the Outpatient Pain Clinic of Menoufia University Hospital in Shebin El-Kom, Egypt. Data were collected using a structured interviewing questionnaire, completed validated self-report measures of the Fear-Avoidance Beliefs Questionnaire (FABQ), the Pain Self-Efficacy Questionnaire (PSEQ), Social Avoidance and Distress Scale (SADS), Posttraumatic Checklist for DSM-5 (PCL-5) and Visual Analogue Pain scale (VAS). Results: Lower pain self-efficacy was significantly predicted by fear-avoidance beliefs (β = -0.448, p <.001). Higher social avoidance and distress behavior were significantly correlated with lower pain self-efficacy (β = -0.564, p <.001). The indirect effect (a × b = 0.253) was statistically significant, as its 95% BCa bootstrap confidence interval [0.110, 0.461] did not cross zero, despite the fact that the total effect of fear-avoidance on social avoidance was significant (β = 0.379, p <.001). Demonstrating that the relationship between fear-avoidance beliefs and social avoidance is fully accounted for by pain self-efficacy. The final model accounted for 44.8% of the variance in social avoidance and distress behavior. Conclusion: Social avoidance in patients with comorbid PTSD and chronic pain is influenced by fear-avoidance beliefs, which are mediated by pain self-efficacy. Interventions that emphasize pain self-efficacy may mitigate social withdrawal and promote functional recovery. Recommendations: Psychiatric and pain-management nurses should integrate pain self-efficacy enhancement programs and cognitive-behavioral strategies into routine care to alleviate fear-avoidance beliefs and mitigate social isolation in this vulnerable population
Source: Egyptian Journal of Health Care
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7222868936