When and why pain-related social support for functional dependence leads to older adults' pain-related disability

Abstract

Background: Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. The temporal relationship between pain-related social support and disability and its behavioral and psychological mediating processes are understudied. Therefore, drawing on the fear-avoidance model of pain (Vlaeyen et al., 1995), the present study aimed at investigating longitudinally (1) the direct effects of pain-related social support for functional autonomy/dependence on pain-related disability, (2) the mediating role of physical functioning, pain-related self-efficacy and fear, and (3) whether pain intensity and pain duration moderate such mediating processes. Methods: 170 older adults (67.6% women; Mage=78.3) participated in a prospective study, with three moments of measurement, with a 6-week lag in-between. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire and the Tampa Scale for Kinesiophobia. Results: Longitudinal mediation and moderated mediation models were tested. Formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3, B=.89). This effect was fully mediated by physical functioning (T2, B=.49) and by pain-related self-efficacy (T2, B=.52), but mainly at shorter pain duration and low/moderate pain intensity. Discussion: Findings clarify the temporal relationship between social support for functional dependence and pain-related disability, uncovering some of its behavioral and psychological mediating processes. These results could inform the development of future training programs with formal caregivers.