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Activity Patterns in Chronic Pain: Underlying Dimensions and Associations With Disability and Depressed Mood
Open accessAbstract
Unlabelled Activity patterns are believed to play an important role in the development and perpetuation of chronic pain. So far, 3 important activity patterns have been studied: avoidance behavior, persistence behavior, and pacing behavior. Yet, empirical evidence is limited and inconclusive about the relationships between these activity patterns and important outcomes. Therefore, the present study was aimed at identifying activity patterns by means of factor analyses and determining their relationship with disability and depressive symptomatology in participants with chronic pain (N = 132). Items across different measurement instruments pertaining to 1 particular activity pattern were aggregated, and submitted to factor analysis. Results from 3 separate factor analyses revealed 6 distinct activity patterns: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. In line with our hypotheses, pain and activity avoidance, and excessive persistence, were related to higher levels of disability and depressive symptomatology. In contrast to hypotheses, pacing was associated with worse outcomes as well. Interestingly, task-contingent persistence was related to lower levels of disability and depressive symptomatology. When controlling for pain and the other activity patterns, excessive persistence and activity avoidance were the most detrimental in terms of relations with depressed mood or disability. Task-contingent persistence appeared to be the least detrimental.Perspective Our findings suggest the existence of several activity patterns, which are differentially related to disability and depressive symptomatology, in participants with chronic pain. The present results are discussed in the light of previous findings, and may provide a new impetus for future studies on activity patterns in chronic pain research.
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“In a previous study, it was stated that the patients in the pacing group may be those who have lost confidence because of the adoption of a wrong pacing strategy”
From Turkish Translation of the Patterns of Activity Measure-Pain in Patients with Chronic Low Back and Neck Pain: Validity and Reliability. (2022) · cites this paper as Kindermans et al., 2011
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THE LIVED EXPERIENCE OF CHRONIC PAIN IN NURSE EDUCATORS
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“Some authors have suggested that such inconsistent results could be explained by pacing being a multidimensional construct rather than a unidimensional one (Kindermans et al., 2011).”
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“…that the POAM-P overdoing scale mainly contains questions related to task-contingent persistence, our results confirm those of Kindermans et al. [45] and also align with the findings of Luthi et al. [46], showing an association between pronounced overdoing behaviour and observational measures…”
BackgroundResultGökdemir, E., Atalay, N. E., Topçuoğlu, M. A., & Özengın, N. (2025) · Black Sea Journal of Health Science · doi:10.19127/bshealthscience.1595211
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“These general activity patterns can be divided into more specific ones depending on the person’s goals [98,99].”
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“Also, pain coping mechanisms were not incorporated, while evidence from populations with chronic pain indicate that different physical activity patterns exist and are hypothesized to be influenced by the underlying coping mechanisms (Hui - jnen et al., 2010; Kindermans et al., 2011).”
Frequencies of persistence, activity pacing, fear avoidance and general stress in acute neck pain
Morf, R., Reicherzer, L., Degenfellner, J., Hasenbring, M. I., Erat, A., & Boendermaker, S. H. (2025) · Zürcher Hochschule für Angewandte Wissenschaften digital collection (Zurich University of Applied Sciences) · doi:10.21256/zhaw-33428
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“Activity pacing, on the other hand, aims to balance activity and regeneration (Kindermans et al. 2011), whereas fear avoidance involves reducing pain-related activities and involves catastrophising (Vlaeyen et al. 2016).”
Mendes, L. P., Barbosa, A. B., Freitas, D. W. D. N., Viana, A. M. A., Santana, A. C. O., Pires, F. D. O., & Dibai‐Filho, A. V. (2026) · Physiotherapy Research International · doi:10.1002/pri.70347
“This behavior may contribute to increased functional disability, particularly when associated with excessive persistence and maladaptive responses to pain (H. P. J. Kindermans et al. 2011).”
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“These patterns are considered clinically relevant because they may reflect, and help explain, psychological state, physical function, and pain interference (5 – 8).”
Towards an understanding of physical activity in people with chronic low back pain
Griffin, D. W. (2013) · University of Limerick · doi:10.34961/7893 · Cited by 1
Metadata
- Authors
- Kindermans, H. P. J., Roelofs, J., Goossens, M. E. J. B., Huijnen, I. P. J., Verbunt, J. A., & Vlaeyen, J. W. S.
- Affiliations
- Maastricht University (NL)
- Corresponding author
- Kindermans, Hanne P.J.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2011-10
- Volume
- 12
- Issue
- 10
- Pages
- 1049-1058
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W2047749593
- Cited by
- 124
- References
- 33
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 11 · 2023: 7 · 2022: 3 · 2021: 11 · 2020: 14 · 2019: 14 · 2018: 7 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 5 · 2012: 9
- FWCI
- 4.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Lirias (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- chronic pain, activity patterns, pain avoidance, activity avoidance, pacing behavior, disability, depressive symptoms, coping strategies
- MeSH terms
- Adolescent, Adult, Aged, Avoidance Learning, Cognition, Depression, Disability Evaluation, Factor Analysis, Statistical, Female, Persons with Disabilities, Humans, Male, Middle Aged, Pain Measurement, Psychiatric Status Rating Scales, Surveys and Questionnaires, Young Adult, Chronic Pain
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