Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = −.767, p < .001 decreasing to B′ = −.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B′ = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults’ experience of chronic pain.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. http://www.apa.org/ethics/code/principles.pdf
Arnstein, P. (2000). The mediation of disability by self efficacy in different samples of chronic pain patients. Disability and Rehabilitation, 22(17), 794–801.
Arnstein, P., Caudill, M., Mandle, C. L., Norris, A., & Beasley, R. (1999). Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain, 80, 483–491.
Azevedo, L. F., Costa-Pereira, A., Mendonça, L., Dias, C. C., & Castro-Lopes, J. M. (2012). Epidemiology of chronic pain: A population based nationwide study on its prevalence, characteristics and associated disability in Portugal. The Journal of Pain, 13, 773–783.
Azevedo, L. F., Pereira, A. C., Dias, C., Agualusa, L., Lemos, L., Romão, J., et al. (2007). Tradução, adaptação cultural e estudo multicêntrico de validação de instrumentos para rastreio e avaliação do impacto da dor crónica. Dor, 15, 6–56.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037//0022-35126.96.36.1993
Bernardes, S. B., Matos, M., & Goubert, L. (submitted). Older adults’ preferences for formal social support of autonomy and dependence in pain: development and validation of a scale.
Benight, C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129–1148.
Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186–204.
Blyth, F. M., March, L. M., Brnabic, A. J. M., Jorm, L. R., Williamson, M., & Cousins, M. J. (2001). Chronic pain in Australia: A prevalence study. Pain, 89, 127–134.
Bolger, N., & Amarel, D. (2007). Effects of social support visibility on adjustment to stress: Experimental evidence. Journal of Personality and Social Psychology, 92, 458–475.
Bolger, N., Zuckerman, A., & Kessler, R. C. (2000). Invisible support and adjustment to stress. Journal of Personality and Social Psychology, 79, 953–961.
Boothy, J. L., Thorn, B. E., Overduin, L. Y., & Ward, L. C. (2004). Catastrophizing and perceived partner responses to pain. Pain, 109, 500–506.
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10, 287–333. doi:10.1016/j.ejpain.2005.06.009
Campbell, P., Wynne-Jones, G., & Dunn, K. M. (2011). The influence of informal social support on risk and prognosis in spinal pain: A systematic review. European Journal of Pain, 15, 444.e1–444.e14.
CIS-IUL. (2013). Ethical guidelines. http://www.cis.iscte-iul.pt/files/Research/LAPSO/ethicsguidelines2013.pdf
Cleeland, C. S. (2009). The Brief Pain Inventory—User guide. http://www.mdanderson.org/education-and-research/departments-programs-and-labs/departments-and-divisions/symptom-research/symptom-assessment-tools/BPI_UserGuide.pdf
Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38, 300–314.
Cohen, S., Gottlieb, B. H., & Underwood, L. G. (2000). Theorectical and historical perspectives. In S. Cohen, L. G. Underwood, & B. H. Gottlieb (Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 3–25). New York: Oxford University Press.
Cohen, S., Janicki-Deverts, D., Turner, R. B., & Doyle, W. J. (2015). Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychological Science, 26(2), 135–147.
Cohen, S., & Syme, S. L. (1985). Issues in the study and application of social support. In S. Cohen & S. L. Syme (Eds.), Social support and health (pp. 3–21). San Francisco: Academic Press.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357. doi:10.1037/0033-2909.98.2.310
Costa, L. D. C. M., Maher, C. G., McAuley, J. H., Hancock, M. J., & Smeets, R. J. (2011). Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. European Journal of Pain, 15(2), 213–219.
Crook, J. M., & Moldofsky, H. (1994). The probability of recovery and return to work from work disability as a function of time. Quality of Life Research, 3, 97–109.
Dellaroza, M. S. G., Pimenta, C. A. M., & Matsuno, T. (2007). Prevalência e caracterização da dor crônica em idosos não institucionalizados. Cadernos de Saúde Pública, 23, 1151–1160.
Denison, E., Åsenlöf, P., & Lindberg, P. (2004). Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care. Pain, 111, 245–252.
Evers, A., Kraaimaat, F., Geenen, R., Jacobs, J., & Bijlsma, J. (2003). Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behaviour Research and Therapy, 41, 1295–1310. doi:10.1016/S0005-7967(03)00036-6
Ferreira, P. L. (2000a). Criação da versão portuguesa do MOS SF-36. Parte I: Adaptação cultural e linguística. Acta Medica Portuguesa, 13, 55–66.
Ferreira, P. L. (2000b). Criação da versão portuguesa do MOS SF-36. Parte II: Testes de validação. Acta Medica Portuguesa, 13(3), 119–127.
Ferrel, B. A. (1995). Pain evaluation and management in the nursing home. Annals of Internal Medicine, 123, 681–687.
Fordyce, W. E. (1976). Behavioral methods for chronic pain and illness. Saint Louis: Mosby.
Gatchel, R. J. (2013). The biopsychosocial model of chronic pain. Clinical Insights: Chronic Pain, 5, 5–17. doi:10.2217/ebo.13.469
Gauler, J. E., & Kane, R. L. (2001). Families and assisted living. Gerontologist, 47, 83–99.
Haneweer, H., Vanheels, L., & Picavet, H. S. (2009). Physical activity and low back pain: A U-shaped relation? Pain, 143, 21–25. doi:10.1016/j.pain.2008.12.033
Hasenbring, M. I., Plaas, H., Fischbein, B., & Willburguer, R. (2006). The relationship between activity and pain in patients 6 months after lumbar disc surgery: Do pain-related coping modes act as moderator variables? European Journal of Pain, 10, 701–709.
Helme, R. D., & Gibson, S. J. (1997). Pain in the elderly. In T. S. Jensen & J. A. Turner (Eds.), Proceedings of the 8th world congress on pain (pp. 919–944). Seattle: IASP Press.
Helme, R. D., & Gibson, S. J. (2001). The epidemiology of pain in elderly people. Clinics in Geriatric Medicine, 17, 417–431.
Hendrick, P., Milosavljevic, S., Hale, L., Hurley, D. A., McDonough, S., Ryan, B., & Baxter, G. D. (2011). The relationship between physical activity and low back pain outcomes: A systematic review of observational studies. European Spine Journal, 20(3), 464–474.
Hughes, S., Jaremka, L. M., Alfano, C. M., Glaser, R., Povoski, S. P., Lipari, A. M., et al. (2014). Social support predicts inflammation, pain, and depressive symptoms: Longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology, 42, 38–44.
Jamison, R. N., & Virts, K. L. (1990). The influence of family support on chronic pain. Behaviour Research and Therapy, 28, 283–287. doi:10.1016/0005-7967(90)90079-X
Johannes, C. B., Le, T. K., Zhou, X., Johnston, J. A., & Dworkin, R. H. (2010). The prevalence of chronic pain in the United States adults: Results of an internet-based survey. The Journal of Pain, 11, 1230–1239.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffee, M. W. (1963). The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185, 914–919.
Kerns, R. D., Southwick, S., Giller, E. L., Haythornthwaite, J. A., Jacob, M. C., & Rosenberg, R. (1991). The relationship between reports of pain-related social interactions and expressions of pain and affective distress. Behavior Therapy, 22, 101–111.
Lafrenière, S. A., Carrière, Y., Martel, L., & Bélanger, A. (2003). Dependent seniors at home-formal and informal help. Health Reports, 14, 31–40.
Lee, J. E., Kahana, B., & Kahana, E. (2015). Social support and cognitive functioning as resources for elderly persons with chronic artritis pain. Aging and Mental Health,. doi:10.1080/13607863.2015.1013920
Leeuw, M., Goossens, M. E., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30, 77–94.
Lethem, J., Slade, P. D., Troup, J. D., & Bentley, G. (1983). Outline of a Fear-Avoidance Model of exaggerated pain perception-I. Behaviour Research and Therapy, 21, 401–408.
Luszczynska, A., Sarkar, Y., & Knoll, N. (2007). Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy. Patient Education and Counseling, 66, 37–42.
Maisel, N. C., & Gable, S. L. (2009). The paradox of received social support. The importance of responsiveness. Psychological Science, 20, 928–932.
Martin, A. L., Halket, E., Asmundson, G. J., Flora, D. B., & Katz, J. (2010). Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery. Clinical Journal of Pain, 26, 518–527.
Matos, M., & Bernardes, S. F. (2013). The Portuguese Formal Social Support for Autonomy and Dependence in Pain Inventory (FSSADI_PAIN): A preliminary validation study. British Journal of Health Psychology, 18, 593–609.
Matos, M., Bernardes, S. F., Goubert, L., & Carvalho, H. (2015). The revised Formal Social Support for Autonomy and Dependence in Pain Inventory (FSSADI_PAIN): Confirmatory factor analysis and validity. The Journal of Pain, 16, 508–517.
Merskey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms (2a ed.). Seattle: IASP Press.
Miranda, V. S., de Carvalho, V. B. F., Machado, L. A. C., & Dias, J. M. D. (2012). Prevalence of chronic musculoskeletal disorder in elderly Brazilians: A systematic review of the literature. Musculoskeletal Disorders, 13, 1–11.
Mobily, P. R., Herr, K. A., Clark, M. K., & Wallace, R. B. (1994). An epidemiologic analysis of pain in the elderly. Journal of Aging and Health, 6, 139–154.
Mort, A., & Philip, L. J. (2014). Social isolation and the perceived importance of in-person care amongst rural older adults with chronic pain: A review and emerging research agenda. Journal of Pain Management, 7, 13–21.
Newton-John, T. R. (2002). Solicitousness and chronic pain: A critical review. Pain Reviews, 9, 7–28.
Nicholas, M. (2007). The pain self-eficaccy questionnaire: Taking pain into account. European Journal of Pain, 11, 153–163.
Nielson, W. R., Jensen, M. P., & Hill, M. L. (2001). An active pacing scale for the chronic pain coping inventory: Development in a sample of patients with fibromyalgia syndrome. Pain, 89, 111–115.
Pereira, L. V., Vasconcelos, P. P., Souza, L. A. F., Pereira, G. A., Nakatani, A. Y. K., & Bachion, M. M. (2004). Prevalência, intensidade de dor crônica e autopercepção de saúde entre idosos: Estudo de base populacional. Revista Latino-Americana de Enfermagem, 22, 662–669. doi:10.1590/0104-1169.3591.2465
Philips, H. C., & Rachman, S. (1996). The role of activity pacing. In H. C. Philips & S. Rachman (Eds.), The psychological management of chronic pain: A treatment manual (pp. 174–184). New York: Springer.
Pinsonnault, E., Desrosiers, J., Dubuc, N., Kalfat, H., Colvez, A., & Delli-Colli, N. (2003). Functional autonomy measurement system: Development of a social subscale. Archives of Gerontology and Geriatrics, 37, 223–233.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Preacher, K. J., & Selig, J. P. (2012). Advantages of monte carlo confidence intervals for indirect effect. Communication Methods and Measures, 6, 77–98.
Raichle, K. A., Romano, J. M., & Jensen, M. O. (2011). Partner responses to patient pain and well behaviors and their relationship to patient pain behaviour, functioning and depressions. Pain, 152, 82–88.
Reyes-Gibby, C. C., Aday, L. A., & Cleeland, C. S. (2002). Impact of pain on self-related health in the community-dwelling older adults. Pain, 95, 75–82.
Roberts, M. H., Klatzkin, R. R., & Mechlin, B. (2015). Social support attenuates physiological stress responses and experimental pain sensivity to cold pressor pain. Annals of Behavioral Medicine, 49, 557–569.
Romano, J. M., Jensen, M. P., Schmaling, K. B., Hops, H., & Buchwald, D. S. (2009). Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses. Journal of Behavioral Medicine, 32, 558–569. doi:10.1007/s10865-009-9234-3
Schwarzer, R., & Knoll, N. (2007). Functional roles of social support within the stress and coping process: A theoretical and empirical overview. International Journal of Psychology, 42, 243–252.
Shen, B. J., McCreary, C. P., & Myers, H. F. (2004). Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation. Journal of Behavioral Medicine, 27, 39–62.
Stubbs, B., Binnekade, T. T., Soundy, A., Schofield, P., Huijnen, I. P. J., & Eggermont, L. H. P. (2013). Are older adults with chronic musculoskeletal pain less active than older adults without pain? A systematic review and meta-analysis. Pain Medicine, 14, 1316–1331.
Sullivan, M. J. L., Adams, H., & Sullivan, M. E. (2004). Communcative dimensions of pain catastrophizing: Social cueing effects on pain behaviour and coping. Pain, 107, 220–226.
Tait, R. C., Chibnall, J. T., & Krause, S. (1990). The pain disability index: Psychometric properties. Pain, 40, 171–182.
Thomas, E., Peat, G., Harris, L., Wilkie, R., & Croft, P. R. (2004). The prevalence of pain and pain interference in a general population of older adults: Cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain, 110, 361–368.
Torrance, N., Smith, B. H., Bennett, M. I., & Lee, A. J. (2006). The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. The Journal of Pain, 7, 281–289.
Turk, D. C. (2002). A diathesis-stress model of chronic pain and disability following traumatic injury. Pain Research and Management, 7, 9–20.
Turk, D. C., & Gatchel, R. J. (Eds.). (2013). Psychological approaches to pain management: A practitioner’s handbook. New York: Guilford Publications.
Turk, D. C., Kerns, R. D., & Rosenberg, R. (1992). Effects of marital interaction on chronic pain and disability: Examining the down side of social support. Rehabilitation Psychology, 37, 259–275.
Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29, 377–387.
Uchino, B. N., Bowen, K., Carlisle, M., & Birmingham, W. (2012). Psychological pathways linking social support to health outcomes: A visit with the “ghosts” of research past, present, and future. Social Science and Medicine, 74, 949–9757. doi:10.1016/j.socscimed.2011.11.023
United Nations. (2013). World Population Ageing. New York: UN. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf
Vlaeyen, J. W., Kole-Snijders, A. M., Rotteveel, A. M., Ruesink, R., & Heuts, P. H. (1995). The role of fear of movement/(re)injury in pain disability. Journal of Occupational Rehabilitation, 5, 235–252.
Wilkie, R., Tajar, A., & McBeth, J. (2013). The onset of widespread musculoskeletal pain is associated with a decrease in healthy ageing in older people: A population-based prospective study. PLoS One, 8(3), e59858.
World Health Organization. (2015). World report on ageing and health. Luxembourg.
Zimmerman, M., Grewal, T., Katz, M., & Lipton, R. (2015). Pain and sleep disturbance in the elderly: Evaluation the role of stress and depression. Neurology, 84, 7–310.
Zyrianova, Y., Kelly, B. D., Gallagher, C., McCarthy, C., Molloy, M. G., Sheehan, J., et al. (2006). Depression and anxiety in rheumatoid arthritis: The role of perceived social support. Irish Journal of Medical Science, 175, 32–36. doi:10.1007/BF03167946
This study was funded by SFRH/BD/79145/2011 Ph.D. grant from Fundação para a Ciência e Tecnologia (FCT).
Conflict of interest
Marta Matos, Sónia F. Bernardes and Liesbet Goubert declare that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures carried out in this study, which involved human participants, were approved by the boards of the participating institutions, where data collection took place. Also, this research was carried out in accordance with the ethical standards as set out in the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.
About this article
Cite this article
Matos, M., Bernardes, S.F. & Goubert, L. The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning. J Behav Med 39, 704–715 (2016). https://doi.org/10.1007/s10865-016-9726-x
- Social support
- Functional autonomy
- Functional dependence
- Physical functioning
- Chronic pain
- Older adults
- Pain-related disability