Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

References

• Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581. doi:10.1037/0033-2909.133.4.581
   PubMed Web of Science ®Google Scholar
• Gerdle B, Rivano Fischer M, Ringqvist Å. Interdisciplinary pain rehabilitation programs: evidence and clinical real-world results. In: Witney A, editor. Pain Management - From Pain Mechanisms to Patient Care [Working Title]. London: IntechOpen; 2022.
   Google Scholar
• Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014;69(2):119–130. doi:10.1037/a0035514
   PubMed Web of Science ®Google Scholar
• Ringqvist Å, Dragioti E, Björk M, Larsson B, Gerdle B. Moderate and stable pain reductions as a result of Interdisciplinary Pain Rehabilitation – a cohort study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med. 2019;8(6):905. doi:10.3390/jcm8060905
   PubMed Web of Science ®Google Scholar
• Gerdle B, Akerblom S, Brodda Jansen G, et al. Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation. J Pain Res. 2019;12:891–908. doi:10.2147/JPR.S190003
   PubMed Web of Science ®Google Scholar
• Vaegter HB, Christoffersen LO, Enggaard TP, et al. Socio-demographics, pain characteristics, quality of life and treatment values before and after specialized interdisciplinary pain treatment: results from the Danish Clinical Pain Registry (PainData). J Pain Res. 2021;14:1215–1230. doi:10.2147/JPR.S306504
   PubMed Web of Science ®Google Scholar
• Elbers S, Wittink H, Konings S, et al. Longitudinal outcome evaluations of Interdisciplinary Multimodal Pain Treatment programmes for patients with chronic primary musculoskeletal pain: a systematic review and meta-analysis. Eur J Pain. 2022;26(2):310–335. doi:10.1002/ejp.1875
   PubMed Web of Science ®Google Scholar
• Bennett M, Closs S. Methodological issues in non pharmacological trials for chronic pain. Pain Clin Updates. 2010;18(2):1–6.
   Google Scholar
• SBU. Methods for Treatment of Chronic Pain a Systematic Review of the Literature (In Swedish: Metoder För Behandling Av Långvarig Smärta: En Systematisk Litteraturöversikt). Vol. 177. Stockholm: SBU – Swedish Council on Health Technology Assessment; 2006:1–2.
   Google Scholar
• SBU. Rehabilitation of Chronic Pain [In Swedish: Rehabilitering Vid Långvarig Smärta. En Systematisk Litteraturöversikt]. Stockholm: SBU – Swedish Council on Health Technology Assessment; 2010.
   Google Scholar
• Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology. 2008;47(5):670–678. doi:10.1093/rheumatology/ken021
   PubMed Web of Science ®Google Scholar
• McCracken LM. Personalized pain management: is it time for process-based therapy for particular people with chronic pain? Eur J Pain. 2023;27(9):1044–1055. doi:10.1002/ejp.2091
   PubMed Web of Science ®Google Scholar
• McCracken LM, Yu L, Vowles KE. New generation psychological treatments in chronic pain. BMJ. 2022;376:e057212.
   PubMedGoogle Scholar
• Trindade IA, Guiomar R, Carvalho SA, et al. Efficacy of online-based acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis. J Pain. 2021;22(11):1328–1342. doi:10.1016/j.jpain.2021.04.003
   PubMed Web of Science ®Google Scholar
• Ma TW, Yuen AS, Yang Z. The efficacy of acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis. Clin J Pain. 2023;39(3):147–157. doi:10.1097/AJP.0000000000001096
   PubMed Web of Science ®Google Scholar
• Fordham B, Sugavanam T, Edwards K, et al. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess. 2021;25(9):1–378. doi:10.3310/hta25090
   PubMed Web of Science ®Google Scholar
• Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and Commitment Therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin J Pain. 2017;33(6):552–568. doi:10.1097/AJP.0000000000000425
   PubMed Web of Science ®Google Scholar
• Lai L, Liu Y, McCracken LM, Li Y, Ren Z. The efficacy of acceptance and commitment therapy for chronic pain: a three-level meta-analysis and a trial sequential analysis of randomized controlled trials. Behav Res Ther. 2023;165:104308. doi:10.1016/j.brat.2023.104308
   PubMed Web of Science ®Google Scholar
• Akerblom S, Perrin S, Rivano Fischer M, McCracken LM. The mediating role of acceptance in multidisciplinary cognitive-behavioral therapy for chronic pain. J Pain. 2015;16(7):606–615. doi:10.1016/j.jpain.2015.03.007
   PubMed Web of Science ®Google Scholar
• Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4:CD011279.
   PubMedGoogle Scholar
• Owen PJ, Miller CT, Mundell NL, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020;54(21):1279–1287. doi:10.1136/bjsports-2019-100886
   PubMed Web of Science ®Google Scholar
• Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155–1167. doi:10.1177/0269215515570379
   PubMed Web of Science ®Google Scholar
• Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract. 2016;32(5):332–355. doi:10.1080/09593985.2016.1194646
   PubMed Web of Science ®Google Scholar
• Tegner H, Frederiksen P, Esbensen BA, Juhl C. Neurophysiological pain education for patients with chronic low back pain: a systematic review and meta-analysis. Clin J Pain. 2018;34(8):778–786. doi:10.1097/AJP.0000000000000594
   PubMed Web of Science ®Google Scholar
• Liechti S, Tseli E, Taeymans J, Grooten W. Prognostic factors for quality of life after interdisciplinary pain rehabilitation in patients with chronic pain-a systematic review. Pain Med. 2023;24(1):52–70. doi:10.1093/pm/pnac098
   PubMed Web of Science ®Google Scholar
• Tseli E, Boersma K, Stalnacke BM, et al. Prognostic factors for physical functioning after multidisciplinary rehabilitation in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. Clin J Pain. 2019;35(2):148–173. doi:10.1097/AJP.0000000000000669
   PubMed Web of Science ®Google Scholar
• Gerdle B, Molander P, Stenberg G, Stalnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-A practice based evidence study from two SQRP centres. BMC Musculoskelet Disord. 2016;17(1):490. doi:10.1186/s12891-016-1346-7
   PubMed Web of Science ®Google Scholar
• Tseli E, Vixner L, LoMartire R, Grooten WJA, Gerdle B, Ang BO. Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: results from a national quality registry in Sweden. J Rehabil Med. 2020. doi:10.2340/16501977-2648
   PubMed Web of Science ®Google Scholar
• Murillo C, Vo TT, Vansteelandt S, et al. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev. 2022;94:102160. doi:10.1016/j.cpr.2022.102160
   PubMed Web of Science ®Google Scholar
• Akerblom S, Perrin S, Rivano Fischer M, McCracken LM. Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility. J Behav Med. 2021;44(1):111–122. doi:10.1007/s10865-020-00168-9
   PubMed Web of Science ®Google Scholar
• Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1–2):9–19. doi:10.1016/j.pain.2004.09.012
   PubMed Web of Science ®Google Scholar
• Turk DC, Dworkin RH, Allen RR, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337–345. doi:10.1016/j.pain.2003.08.001
   PubMed Web of Science ®Google Scholar
• Kaiser U, Kopkow C, Deckert S, et al. Developing a core outcome-domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome-domains. Pain. 2018;159(4):673–683. doi:10.1097/j.pain.0000000000001129
   PubMed Web of Science ®Google Scholar
• Gerdle B, Åkerblom S, Stålnacke B-M, et al. The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation – a SQRP study of more than 20 000 chronic pain patients. Scand J Pain. 2019;19(4):693–711. doi:10.1515/sjpain-2019-0016
   PubMed Web of Science ®Google Scholar
• de Rooij A, Roorda LD, Otten RHJ, van der Leeden M, Dekker J, Steultjens MPM. Predictors of multidisciplinary treatment outcome in fibromyalgia: a systematic review. Disabil Rehabil. 2013;35(6):437–449. doi:10.3109/09638288.2012.699582
   PubMed Web of Science ®Google Scholar
• Craner JR, Flegge LG, Lake ES, Perra AEA. Patients with clinically elevated depressive symptoms report improvements in mood, pain, and functioning following participation in interdisciplinary pain rehabilitation. Pain Med. 2022;23(2):362–374. doi:10.1093/pm/pnab242
   PubMed Web of Science ®Google Scholar
• Oliveira DS, Velia Ferreira Mendonca L, Sofia Monteiro Sampaio R, Manuel Pereira Dias de castro-lopes J, Ribeiro de Azevedo LF. The impact of anxiety and depression on the outcomes of chronic low back pain multidisciplinary pain management-a multicenter prospective cohort study in pain clinics with one-year follow-up. Pain Med. 2019;20(4):736–746. doi:10.1093/pm/pny128
   PubMed Web of Science ®Google Scholar
• Lewis GN, Bean DJ. What influences outcomes from inpatient multidisciplinary pain management programs? A systematic review and meta-analysis. Clin J Pain. 2021;37(7):504–523. doi:10.1097/AJP.0000000000000941
   PubMed Web of Science ®Google Scholar
• Fordham B, Sugavanam T, Hopewell S, et al. Effectiveness of cognitive-behavioural therapy: a protocol for an overview of systematic reviews and meta-analyses. BMJ open. 2018;8(12):e025761. doi:10.1136/bmjopen-2018-025761
   PubMed Web of Science ®Google Scholar
• Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):1144–1147. doi:10.1016/j.pain.2011.12.009
   PubMed Web of Science ®Google Scholar
• Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016;157(8):1588–1589. doi:10.1097/j.pain.0000000000000574
   PubMed Web of Science ®Google Scholar
• Gatchel RJ, Neblett R, Kishino N, Ray CT. Fear-avoidance beliefs and chronic pain. J Orthop Sports Phys Ther. 2016;46(2):38–43. doi:10.2519/jospt.2016.0601
   PubMed Web of Science ®Google Scholar
• Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999;19(1):97–119. doi:10.1016/S0272-7358(98)00034-8
   PubMed Web of Science ®Google Scholar
• Norton PJ, Asmundson GJG. Amending the fear-avoidance model of chronic pain: what is the role of physiological arousal? Behavior Ther. 2003;34(1):17–30. doi:10.1016/S0005-7894(03)80019-9
   Web of Science ®Google Scholar
• Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–332. doi:10.1016/S0304-3959(99)00242-0
   PubMed Web of Science ®Google Scholar
• Vlaeyen J, Kole-Snijders A, Boeren R, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62:363–372. doi:10.1016/0304-3959(94)00279-N
   PubMed Web of Science ®Google Scholar
• Neblett R, Mayer TG, Williams MJ, et al. The Fear-Avoidance Components Scale (FACS): responsiveness to functional restoration treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population. Clin J Pain. 2017;33(12):1088–1099. doi:10.1097/AJP.0000000000000501
   PubMed Web of Science ®Google Scholar
• Zale EL, Ditre JW. Pain-related fear, disability, and the fear-avoidance model of chronic pain. Curr Opin Psychol. 2015;5:24–30. doi:10.1016/j.copsyc.2015.03.014
   PubMed Web of Science ®Google Scholar
• Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-A moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–2678. doi:10.1016/j.spinee.2014.02.033
   PubMed Web of Science ®Google Scholar
• Krismer M, van Tulder M; Low Back Pain Group of the B, Joint Health Strategies for Europe P. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol. 2007;21(1):77–91. doi:10.1016/j.berh.2006.08.004
   PubMed Web of Science ®Google Scholar
• Leeuw M, Goossens ME, van Breukelen GJ, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 2008;138(1):192–207. doi:10.1016/j.pain.2007.12.009
   PubMed Web of Science ®Google Scholar
• Lundberg M, Larsson M, Ostlund H, Styf J. Kinesiophobia among patients with musculoskeletal pain in primary healthcare. J Rehabil Med. 2006;38(1):37–43. doi:10.1080/16501970510041253
   PubMed Web of Science ®Google Scholar
• Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816–836 e814. doi:10.1016/j.spinee.2013.09.036
   PubMed Web of Science ®Google Scholar
• Kroska EB. A meta-analysis of fear-avoidance and pain intensity: the paradox of chronic pain. Scand J Pain. 2016;13(1):43–58. doi:10.1016/j.sjpain.2016.06.011
   PubMedGoogle Scholar
• Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain-related fear, pain intensity and function in individuals with chronic musculoskeletal pain: a systematic review and meta-analysis. J Pain. 2019;20(12):1394–1415. doi:10.1016/j.jpain.2019.04.009
   PubMed Web of Science ®Google Scholar
• Rogers AH, Farris SG. A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. Eur J Pain. 2022;26(8):1611–1635. doi:10.1002/ejp.1994
   PubMed Web of Science ®Google Scholar
• Hayes SB, Strosahl K, Wilson K. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed. New York: Guilford Press; 2012.
   Google Scholar
• McCracken LM. Psychological flexibility, chronic pain, and health. Annual Review of Psychology. 2023. doi:10.1146/annurev-psych-020223-124335
   PubMedGoogle Scholar
• McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014;69(2):178–187. doi:10.1037/a0035623
   PubMed Web of Science ®Google Scholar
• Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180–198. doi:10.1016/j.beth.2009.08.002
   PubMed Web of Science ®Google Scholar
• Asghari A, Nicholas MK. Personality and pain-related beliefs/coping strategies: a prospective study. Clin J Pain. 2006;22(1):10–18. doi:10.1097/01.ajp.0000146218.31780.0b
   PubMed Web of Science ®Google Scholar
• Esteve R, Ramirez-Maestre C, Lopez-Marinez AE. Adjustment to chronic pain: the role of pain acceptance, coping strategies, and pain-related cognitions. Ann Behav Med. 2007;33(2):179–188. doi:10.1007/BF02879899
   PubMed Web of Science ®Google Scholar
• Hayes S, Jacobson N, Follette V, Dougher M. Acceptance and Change: Content and Context in Psychotherapy. Reno: Context Press; 1994.
   Google Scholar
• McCracken L. Commentary: toward understanding acceptance and psychological flexibility in chronic pain. Pain. 2010;149(3):420–421. doi:10.1016/j.pain.2010.02.036
   PubMed Web of Science ®Google Scholar
• Scott W, McCracken L. Psychological flexibility, acceptance and commitment therapy, and chronic pain. Curr Opin Psychol. 2015;2:91–96. doi:10.1016/j.copsyc.2014.12.013
   Web of Science ®Google Scholar
• McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74(1):21–27. doi:10.1016/S0304-3959(97)00146-2
   PubMed Web of Science ®Google Scholar
• Cederberg JT, Cernvall M, Dahl J, von Essen L, Ljungman G. Acceptance as a mediator for change in acceptance and commitment therapy for persons with chronic pain? Int J Behav Med. 2016;23(1):21–29. doi:10.1007/s12529-015-9494-y
   PubMed Web of Science ®Google Scholar
• Kranz D, Bollinger A, Nilges P. Chronic pain acceptance and affective well-being: a coping perspective. Eur J Pain. 2010;14(10):1021–1025. doi:10.1016/j.ejpain.2010.03.010
   PubMed Web of Science ®Google Scholar
• McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain. 2005;118(1–2):164–169. doi:10.1016/j.pain.2005.08.015
   PubMed Web of Science ®Google Scholar
• Viane I, Crombez G, Eccleston C, Devulder J, De Corte W. Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities. Pain. 2004;112(3):282–288. doi:10.1016/j.pain.2004.09.008
   PubMed Web of Science ®Google Scholar
• McCracken LM, Spertus IL, Janeck AS, Sinclair D, Wetzel FT. Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain. 1999;80(1–2):283–289. doi:10.1016/S0304-3959(98)00219-X
   PubMed Web of Science ®Google Scholar
• Viane I, Crombez G, Eccleston C, et al. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain. 2003;106(1–2):65–72. doi:10.1016/S0304-3959(03)00291-4
   PubMed Web of Science ®Google Scholar
• Karayannis N, Sturgeon J, Kemani M, et al. Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology. Scand J Pain. 2023;23(3):464–475. doi:10.1515/sjpain-2022-0107
   PubMed Web of Science ®Google Scholar
• Fordham B, Ji C, Hansen Z, Lall R, Lamb SE. Explaining how cognitive behavioral approaches work for low back pain: mediation analysis of the back skills training trial. Spine. 2017;42(17):E1031–E1039. doi:10.1097/BRS.0000000000002066
   PubMed Web of Science ®Google Scholar
• Stockton D, Kellett S, Berrios R, Sirois F, Wilkinson N, Miles G. Identifying the underlying mechanisms of change during Acceptance and Commitment Therapy (ACT): a systematic review of contemporary mediation studies. Behav Cogn Psychother. 2019;47(3):332–362. doi:10.1017/S1352465818000553
   PubMed Web of Science ®Google Scholar
• Svanberg M, Stalnacke BM, Enthoven P, Brodda-Jansen G, Gerdle B, Boersma K. Impact of emotional distress and pain-related fear on patients with chronic pain: subgroup analysis of patients referred to multimodal rehabilitation. J Rehabil Med. 2017;49(4):354–361. doi:10.2340/16501977-2212
   PubMed Web of Science ®Google Scholar
• Pester BD, Crouch TB, Christon L, et al. Gender differences in multidisciplinary pain rehabilitation: the mediating role of pain acceptance. J Context Behav Sci. 2022;23:117–124. doi:10.1016/j.jcbs.2022.01.002
   Web of Science ®Google Scholar
• Gerdle B, Boersma K, Asenlof P, Stalnacke BM, Larsson B, Ringqvist A. Influences of sex, education, and country of birth on clinical presentations and overall outcomes of interdisciplinary pain rehabilitation in chronic pain patients: a cohort study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med. 2020;9(8):2374. doi:10.3390/jcm9082374
   PubMed Web of Science ®Google Scholar
• Flegge LG, Lake E, Truesdale C, Craner JR. Sex differences in interdisciplinary pain rehabilitation outcomes: a systematic review. Scand J Pain. 2022;22(2):218–231. doi:10.1515/sjpain-2021-0188
   PubMed Web of Science ®Google Scholar
• Krogstad BS, Jokstad A, Dahl BL, Vassend O. The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences. J Orofac Pain. 1996;10(3):263–269.
   PubMedGoogle Scholar
• Spinord L, Kassberg AC, Stenberg G, Lundqvist R, Stalnacke BM. Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age. J Rehabil Med. 2018;50(7):619–628. doi:10.2340/16501977-2352
   PubMed Web of Science ®Google Scholar
• Murphy JL, Phillips KM, Rafie S. Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation. J Rehabil Res Dev. 2016;53(1):83–94. doi:10.1682/JRRD.2014.10.0250
   PubMedGoogle Scholar
• Danielsson L, Kvarstein G, Bergvik S. Mediators of pain and physical function in female and male patients with chronic pain. J Pain Res. 2020;13:1059–1071. doi:10.2147/JPR.S233501
   PubMed Web of Science ®Google Scholar
• Bromley Milton M, Borsbo B, Rovner G, Lundgren-Nilsson A, Stibrant-Sunnerhagen K, Gerdle B. Is pain intensity really that important to assess in chronic pain patients? A study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP). PLoS One. 2013;8(6):e65483. doi:10.1371/journal.pone.0065483
   PubMed Web of Science ®Google Scholar
• Rivano Fischer M, Schults M, Stålnacke B, Ekholm J, Persson E, Löfgren M. Variability in patient characteristics and service provision of interdisciplinary pain rehabilitation: a study using the Swedish national quality registry for pain rehabilitation. J Rehabil Med. 2020;52(11):jrm00128.
   PubMed Web of Science ®Google Scholar
• Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336(7656):1281–1283. doi:10.1136/bmj.39569.510521.AD
   PubMed Web of Science ®Google Scholar
• Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.
   PubMed Web of Science ®Google Scholar
• Gerdle B, Cervin M, Rivano Fischer M, Ringqvist A. Outcomes of interdisciplinary pain rehabilitation across subgroups of the multidimensional pain inventory - a study from the Swedish Quality Registry for Pain Rehabilitation. Pain Pract. 2021;21(6):662–679. doi:10.1111/papr.13007
   PubMed Web of Science ®Google Scholar
• Gerdle B, Rivano Fischer M, Cervin M, Ringqvist Å. Spreading of pain in patients with chronic pain is related to pain duration and clinical presentation and weakly associated with outcomes of interdisciplinary pain rehabilitation: a cohort study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res. 2021;14:173–187. doi:10.2147/JPR.S288638
   PubMed Web of Science ®Google Scholar
• Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x
   PubMed Web of Science ®Google Scholar
• Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.
   PubMed Web of Science ®Google Scholar
• LoMartire R, Ang BO, Gerdle B, Vixner L. Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain. Pain. 2020;161(1):83–95. doi:10.1097/j.pain.0000000000001700
   PubMed Web of Science ®Google Scholar
• Roelofs J, Sluiter J, Frings-Dresen M, et al. Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain. 2007;131(1):181–190. doi:10.1016/j.pain.2007.01.008
   PubMed Web of Science ®Google Scholar
• Rovner GS, Arestedt K, Gerdle B, Borsbo B, McCracken LM. Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish chronic pain cohort. J Rehabil Med. 2014;46(1):73–80. doi:10.2340/16501977-1227
   PubMed Web of Science ®Google Scholar
• EuroQol. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208. doi:10.1016/0168-8510(90)90421-9
   PubMed Web of Science ®Google Scholar
• Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72. doi:10.1016/0168-8510(96)00822-6
   PubMed Web of Science ®Google Scholar
• Dolan P, Sutton M. Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Soc Sci Med. 1997;44(10):1519–1530. doi:10.1016/S0277-9536(96)00271-7
   PubMed Web of Science ®Google Scholar
• Bäckryd E, Persson EB, Larsson AI, Fischer MR, Gerdle B. Chronic pain patients can be classified into four groups: clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study). PLoS One. 2018;13(2):e0192623. doi:10.1371/journal.pone.0192623
   PubMed Web of Science ®Google Scholar
• Eriksson L, Byrne T, Johansson E, Trygg J, Vikström C. Multi- and Megavariate Data Analysis: Basic Principles and Applications. Third revised edition ed. Malmö: MKS Umetrics AB; 2013.
   Google Scholar
• Hair JJ, Hult G, Ringle C, Sarstedt M. A Primer on Partial Least Squares Structural Equation Modelling (PLS-SEM). Third ed. SAGE; 2022.
   Google Scholar
• Chua Y. A Step-By-Step Guide: PLS-SEM Data Analysis Using SmartPLS 4. Kuala Lumpur: Researchtree Education; 2023.
   Google Scholar
• Sheko A, Braimllari A. Information technology inhibitors and information quality in supply chain management: a PLS-SEM analysis. Acad J Interdiscip Stud. 2018;7(3):125–138. doi:10.2478/ajis-2018-0064
   Google Scholar
• Heelas L, Soni A, Barker K. Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme? Br J Pain. 2023;17(6):532–545. doi:10.1177/20494637231190190
   PubMedGoogle Scholar
• Martinez-Calderon J, Jensen MP, Morales-Asencio JM, Luque-Suarez A. Pain catastrophizing and function in individuals with chronic musculoskeletal pain: a systematic review and meta-analysis. Clin J Pain. 2019;35(3):279–293. doi:10.1097/AJP.0000000000000676
   PubMed Web of Science ®Google Scholar
• Craner JR, Lake ES, Bancroft KA, George LL. Treatment outcomes and mechanisms for an ACT-based 10-week interdisciplinary chronic pain rehabilitation program. Pain Pract. 2020;20(1):44–54. doi:10.1111/papr.12824
   PubMed Web of Science ®Google Scholar
• Lee H, Hubscher M, Moseley GL, et al. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain. 2015;156(6):988–997. doi:10.1097/j.pain.0000000000000146
   PubMed Web of Science ®Google Scholar
• Hooten W. Chronic pain and mental health disorders: shared neural mechanisms, epidemiology, and treatment. Mayo Clin Proc. 2016;91(7):955–970. doi:10.1016/j.mayocp.2016.04.029
   PubMed Web of Science ®Google Scholar
• Armbrecht E, Shah A, Schepman P, et al. Economic and humanistic burden associated with noncommunicable diseases among adults with depression and anxiety in the United States. J Med Econ. 2020;23(9):1032–1042. doi:10.1080/13696998.2020.1776297
   PubMed Web of Science ®Google Scholar
• Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–2445. doi:10.1001/archinte.163.20.2433
   PubMed Web of Science ®Google Scholar
• Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13(2):116–137. doi:10.1097/00002508-199706000-00006
   PubMed Web of Science ®Google Scholar
• May A. Chronic pain may change the structure of the brain. Pain. 2008;137(1):7–15. doi:10.1016/j.pain.2008.02.034
   PubMed Web of Science ®Google Scholar
• Romano JM, Turner JA. Chronic pain and depression: does the evidence support a relationship? Psychol Bull. 1985;97(1):18–34. doi:10.1037/0033-2909.97.1.18
   PubMed Web of Science ®Google Scholar
• Stubbs B, Koyanagi A, Thompson T, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016;43:63–70. doi:10.1016/j.genhosppsych.2016.09.008
   PubMed Web of Science ®Google Scholar
• Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol. 2022;19(11):717–726. doi:10.1038/s41575-022-00634-6
   PubMed Web of Science ®Google Scholar
• Angst F, Benz T, Lehmann S, et al. Extended overview of the longitudinal pain-depression association: a comparison of six cohorts treated for specific chronic pain conditions. J Affect Disord. 2020;273:508–516. doi:10.1016/j.jad.2020.05.044
   PubMed Web of Science ®Google Scholar
• Qiu Y, Ma Y, Huang X. Bidirectional relationship between body pain and depressive symptoms: a pooled analysis of two national aging cohort studies. Front Psychiatry. 2022;13:881779. doi:10.3389/fpsyt.2022.881779
   PubMedGoogle Scholar
• Zhu Z, Galatzer-Levy IR, Bonanno GA. Heterogeneous depression responses to chronic pain onset among middle-aged adults: a prospective study. Psychiatry Res. 2014;217(1–2):60–66. doi:10.1016/j.psychres.2014.03.004
   PubMed Web of Science ®Google Scholar
• Leino-Arjas P, Rajaleid K, Mekuria G, Nummi T, Virtanen P, Hammarstrom A. Trajectories of musculoskeletal pain from adolescence to middle age: the role of early depressive symptoms, a 27-year follow-up of the Northern Swedish Cohort. Pain. 2018;159(1):67–74. doi:10.1097/j.pain.0000000000001065
   PubMed Web of Science ®Google Scholar
• Schneider S, Junghaenel DU, Keefe FJ, Schwartz JE, Stone AA, Broderick JE. Individual differences in the day-to-day variability of pain, fatigue, and well-being in patients with rheumatic disease: associations with psychological variables. Pain. 2012;153(4):813–822. doi:10.1016/j.pain.2012.01.001
   PubMed Web of Science ®Google Scholar
• Page MG, Gauvin L, Sylvestre MP, Nitulescu R, Dyachenko A, Choiniere M. An ecological momentary assessment study of pain intensity variability: ascertaining extent, predictors, and associations with quality of life, interference and health care utilization among individuals living with chronic low back pain. J Pain. 2022;23(7):1151–1166. doi:10.1016/j.jpain.2022.01.001
   PubMed Web of Science ®Google Scholar
• Bondesson E, Larrosa Pardo F, Stigmar K, et al. Comorbidity between pain and mental illness – evidence of a bidirectional relationship. Eur J Pain. 2018;22(7):1304–1311. doi:10.1002/ejp.1218
   PubMed Web of Science ®Google Scholar
• Akerblom S, Cervin M, Perrin S, Rivano Fischer M, Gerdle B, McCracken LM. A network analysis of clinical variables in chronic pain: a study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Pain Med. 2021;22(7):1591–1602. doi:10.1093/pm/pnaa473
   PubMed Web of Science ®Google Scholar
• Zhao X, Boersma K, Gerdle B, Molander P, Hesser H. Fear network and pain extent: interplays among psychological constructs related to the fear-avoidance model. J Psychosom Res. 2023;167:111176. doi:10.1016/j.jpsychores.2023.111176
   PubMed Web of Science ®Google Scholar
• Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist A. Pain intensity and psychological distress show different associations with interference and lack of life control: a clinical registry-based cohort study of >40,000 chronic pain patients from SQRP. Front Pain Res. 2023;4:1093002. doi:10.3389/fpain.2023.1093002
   Google Scholar
• Alhowimel AS, Alotaibi MA, Alenazi AM, et al. Psychosocial predictors of pain and disability outcomes in people with chronic low back pain treated conservatively by guideline-based intervention: a systematic review. J Multidiscipl Healthc. 2021;14:3549–3559. doi:10.2147/JMDH.S343494
   PubMedGoogle Scholar
• Jensen MP. Psychosocial approaches to pain management: an organizational framework. Pain. 2011;152(4):717–725. doi:10.1016/j.pain.2010.09.002
   PubMed Web of Science ®Google Scholar
• Windgassen S, Goldsmith K, Moss-Morris R, Chalder T. Establishing how psychological therapies work: the importance of mediation analysis. J Ment Health. 2016;25(2):93–99. doi:10.3109/09638237.2015.1124400
   PubMed Web of Science ®Google Scholar
• Alaiti RK, Castro J, Lee H, et al. What are the mechanisms of action of cognitive-behavioral, mind-body, and exercise-based interventions for pain and disability in people with chronic primary musculoskeletal pain? A systematic review of mediation studies from randomized controlled trials. Clin J Pain. 2022;38(7):502–509. doi:10.1097/AJP.0000000000001047
   PubMed Web of Science ®Google Scholar
• Shields GS, Spahr CM, Slavich GM. Psychosocial interventions and immune system function: a systematic review and meta-analysis of randomized clinical trials. JAMA psychiatry. 2020;77(10):1031–1043. doi:10.1001/jamapsychiatry.2020.0431
   PubMed Web of Science ®Google Scholar
• Kuna K, Szewczyk K, Gabryelska A, et al. Potential role of sleep deficiency in inducing immune dysfunction. Biomedicines. 2022;10(9):2159. doi:10.3390/biomedicines10092159
   PubMed Web of Science ®Google Scholar
• Scheffer DDL, Latini A. Exercise-induced immune system response: anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis. 2020;1866(10):165823. doi:10.1016/j.bbadis.2020.165823
   PubMed Web of Science ®Google Scholar
• Hysing EB, Smith L, Thulin M, Karlsten R, Bothelius K, Gordh T. Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program. Scand J Pain. 2019;19(2):235–244. doi:10.1515/sjpain-2018-0340
   PubMed Web of Science ®Google Scholar
• Wåhlen K, Yan H, Welinder C, et al. Proteomic investigation in plasma from women with fibromyalgia in response to a 15-wk resistance exercise intervention. Med Sci Sports Exerc. 2022;54(2):232–246. doi:10.1249/MSS.0000000000002790
   PubMed Web of Science ®Google Scholar
• Maric M, Wiers RW, Prins PJ. Ten ways to improve the use of statistical mediation analysis in the practice of child and adolescent treatment research. Clinical Child and Family Psychology Review. 2012;15(3):177–191. doi:10.1007/s10567-012-0114-y
   PubMed Web of Science ®Google Scholar
• Waller G, Turner H. Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behav Res Ther. 2016;77:129–137. doi:10.1016/j.brat.2015.12.005
   PubMed Web of Science ®Google Scholar
• Angst F, Lehmann S, Sandor PS, Benz T. Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain. Eur J Pain. 2022;26(7):1569–1580. doi:10.1002/ejp.1983
   PubMed Web of Science ®Google Scholar
• Ghafouri N, Backryd E, Dragioti E, Rivano Fischer M, Ringqvist A, Gerdle B. Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions - A registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP). BMC Musculoskelet Disord. 2023;24(1):357. doi:10.1186/s12891-023-06462-2
   PubMed Web of Science ®Google Scholar
• Gilpin HR, Stahl DR, McCracken LM. A theoretically guided approach to identifying predictors of treatment outcome in Contextual Cognitive Behavioural Therapy for chronic pain. Eur J Pain. 2019;23(2):354–366. doi:10.1002/ejp.1310
   PubMed Web of Science ®Google Scholar
• Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther. 2017;98:39–57. doi:10.1016/j.brat.2016.11.001
   PubMed Web of Science ®Google Scholar