Psychological Determinants of Functionality in Chronic Musculoskeletal Pain: A Structural Equation Modeling Approach

Abstract

Objective: – Beyond nociceptive mechanisms, the experience of pain is shaped by emotional, cognitive, and behavioral processes. The main hypothesis of this study is that beliefs about pain and intolerance of uncertainty may influence susceptibility to catastrophic pain, and that catastrophic pain may determine the severity of chronic pain and the limitation of daily life activities. Design: – A total of 173 patients with chronic musculoskeletal pain were assessed using the Pain Belief Questionnaire, Intolerance of Uncertainty Scale-12, Pain Catastrophizing Scale, and the Brief Pain Inventory. Structural Equation Modeling was conducted using IBM-AMOS. Results: – According to these findings, intolerance to uncertainty was effective in functionality through Pain Catastrophizing Scale. In addition, Pain Catastrophizing Scale had a direct effect. On the other hand, no significant effect of Pain Belief Questionnaire and pain severity on functionality was found. Conclusions: – These findings show that the way of interpreting pain, rather than its severity, affects daily function in patients with chronic pain. We found that Intolerance of Uncertainty and Pain Catastrophizing are important determinants of pain perception and physical function in chronic pain patients. We believe that multidisciplinary treatments, in which psychological factors are considered, will be more successful in the treatment of chronic pain. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.