Catastrophizing Linked to Worse Perceived Pain After Fibromyalgia Walk Test

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Investigators hypothesized that patients with fibromyalgia who avoid activities because of pain would be more likely to perceive more intense pain levels after walking due to catastrophizing.

Motivational interventions may improve the symptoms of fibromyalgia because objectives emphasize managing conflict goals, according to a study published in Biomedicines.1 Specifically, interventions should focus on catastrophic cognitions as pain catastrophizing was shown to be a major inhibitor of physical activity in this patient population.

“Despite the support received from motivational theories explaining the maintenance of pain and lack of adherence to walking patterns in fibromyalgia patients, there are few studies on the influence of goals on symptoms such as pain or fatigue in chronic pain pathologies, as well as the role of pain catastrophizing in goal conflict and the deterioration of symptoms,” Lorena Gutiérrez, PhD, professor of psychology at the Universidad Rey Juan Carlos, and colleagues, explained. “Therefore, the main objective of the present study focuses on the exploration of the influence of a sedentary lifestyle on pain severity in terms of the preference for pain avoidance goals and the level of catastrophizing controlling the effect of pain chronicity.”

Investigators hypothesized that patients with fibromyalgia who avoid activities because of pain would be more likely to perceive more intense levels of pain after walking based on pain catastrophizing. The study was a part of a larger study evaluating pain catastrophizing and conflicts regarding walking pain. A preliminary evaluation obtained demographic and clinical characteristics.

Patients’ history of sedentary behavior, preference of pain-avoidance goals, and pain catastrophizing were evaluated via the Pain Catastrophizing Scale, Goal Pursuit Questionnaire, and the International Physical Activity Questionnaire before initiating a 6-minute walking test (6MWT). The test measured the maximum distance a person can cover in 6 minutes walking as fast as possible. After completing the 6MWT, pain perception was evaluated.

The cohort, recruited from Community of Madrid and Castilla-La Mancha in Spain, included 76 women with fibromyalgia, with a mean age of 55.05 years and a disease duration of 12.32 years.

A significant moderated-mediation model was observed in which pain-avoidance mediated the relationship between sedentarism and pain after the walking-test, while pain catastrophizing moderated the relationship between the preference for pain-avoidance and pain perception. Patients reporting high levels of pain catastrophizing had increased pain perceptions after completing the test (B = 0.570, P = 0.03, confidence interval [CI] 95% [0.09, 0.11]).

A significant effect was observed in patients with sedentary lifestyle on pain perception through avoidance activity preference (path b) (b = 0.55; P = 0.0047; [CI = 0.057–1.102]). Previous sedentary behavior on pain perception was also significant (path c) (c = 0.120; P = 0.038; [CI = 0.015–0.038]). These findings show that a history of sedentary behavior results in a preference for avoidance of pain-related activities. Further, activity avoidance was linked to greater pain after the walking test.

The observational study design, coupled with the low sample size consisting of only female patients, prevents generalization. Despite this, the sample was similar to that of previous studies involving the 6MWT for patients with chronic pain.

“A multidisciplinary approach based on attention to psychological factors such as catastrophic beliefs about pain and internal conflict about avoidance vs activity goals could help patients with fibromyalgia to overcome their medical condition and cope with the difficulties associated with the disease,” Gutiérrez concluded. “Since walking is an accessible, easy exercise with favorable health outcomes for patients, enhancing the intention to initiate this behavior as a rehabilitation guideline within the multidisciplinary context is encouraged.”


Gutiérrez L, Écija C, Catalá P, Peñacoba C. Sedentary Behavior and Pain after Physical Activity in Women with Fibromyalgia-The Influence of Pain-Avoidance Goals and Catastrophizing. Biomedicines. 2023 Jan 7;11(1):154. doi: 10.3390/biomedicines11010154. PMID: 36672662; PMCID: PMC9855630.