Mind-Body Activity Program for Chronic Pain: Exploring Mechanisms of Improvement in Patient-Reported, Performance-Based and Ambulatory Physical Function
Open accessAbstract
BACKGROUND: Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood. PURPOSE: To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program. METHODS: Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline. RESULTS: Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=-.14; CI=-25, -.05; medium effect size) and pain resilience (CSIE=-.07; CI=-.16, -.005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=-.11; CI=-23, -.008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function. CONCLUSION: Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function. TRIAL REGISTRATION: ClinicalTrials.gov NCT03412916.
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Pain acceptance addresses pain catastrophizing and kinesiophobia.
“pain acceptance addresses: (1) pain catastrophizing, which is an exaggerated cognitive or emotional response to actual or anticipated pain [51-53], and (2) kinesiophobia, which is the avoidance of activities or movements due to excessive anxiety that it will cause pain or injury [54].”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [51]
The Measures > Proposed Mediators section defines kinesiophobia as fear of pain due to movement, supporting the core of the definition attached to this citation. The Discussion says that fear can limit physical function, but the cited paper does not explicitly define kinesiophobia as avoidance driven by anxiety about pain or injury. It also does not establish that pain acceptance addresses kinesiophobia or pain catastrophizing. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPrior studies by Vranceanu's team showed that pain catastrophizing, kinesiophobia, mindfulness, and pain resilience are mediators of mental and physical health in people with chronic pain.
“This study complements prior studies performed by Vranceanu’s team [51,52] which showed that pain catastrophizing, kinesiophobia, mindfulness, and pain resilience are mediators of mental and physical health in people with chronic pain.”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [51]
The Discussion reports that kinesiophobia, mindfulness, and pain resilience mediated improvements in patient-reported physical function in people with chronic pain. The Proposed Mediators section says pain catastrophizing was not included in the mediation models, and the reported outcome was physical function, not mental health. Page numbers were not provided in our copy. (LLM, conf=0.90)
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- Authors
- Greenberg, J., Mace, R. A., Bannon, S. M., Kulich, R. J., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Vranceanu, Ana-Maria
- Venue
- Journal of Pain Research
- Publisher
- Informa UK Limited
- Published
- 2021-02
- Volume
- Volume 14
- Pages
- 359-368
- ISSN
- 1178-7090 (ISSN-L)
- PMC
- PMC7872894
- OpenAlex
- W3128929988
- Cited by
- 12
- References
- 42
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 1
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pain Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- National Center for Complementary and Integrative Health (R34AT009356, K23AT010653)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- chronic pain, physical function, kinesiophobia, mindfulness, pain resilience, mediation analysis, Fitbit, 6-minute walk test, WHODAS 2.0, psychosocial mediators
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