197: Predicting Disability Beyond Pain Intensity: Psychological Factors in a Malaysia Private Pain Clinic

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Functional disability in pain populations is a complex outcome influenced by more than just subjective pain intensity [1,2]. In Malaysia, pain medicine has emerged as a specialised clinical service focused on multidisciplinary strategies to improve quality of life [3]. However, there remains a lack of empirical data within Malaysian pain healthcare regarding how emotional distress and pain-specific cognitive-behavioural factors uniquely contribute to functional impairment [4,5]. This study aimed to evaluate the incremental validity of emotional distress (depression, anxiety, stress) and pain-specific cognitive-behavioural variables (self-efficacy, self-statements, self-management) in predicting disability beyond the variance explained by pain intensity.

Methods: This retrospective cross-sectional study evaluated N=110 outpatients at a multidisciplinary pain clinic within a Malaysian private hospital (2019–2025). During intake, patients completed the Roland-Morris Disability Questionnaire – Modified (RMDQ), a 0–10 numerical pain rating for usual pain rating in last week, Depression Anxiety and Stress Scale (DASS-42), Pain Self-Efficacy Questionnaire (PSEQ), Pain Self-Management Checklist (PSMC-1), and Pain-Related Self-Statements (PRSS). A three-step hierarchical multiple regression assessed the incremental validity of psychological factors in predicting functional disability. Step 1 controlled for pain intensity; Step 2 entered emotional distress (DASS subscales); Step 3 added cognitive-behavioural variables (self-efficacy, self-management, and self-statements).

Results: The final hierarchical model was statistically significant [F(8, 101) = 12.487, p < .001], explaining 49.7% of the variance in functional disability (R2 = .497). Step 1 (Pain Intensity) explained 14.8% of the variance (p < .001). The addition of emotional distress in Step 2 contributed an additional 16.2% (R2 = .162, p < .001). Finally, cognitive-behavioural variables in Step 3 explained a further 18.7% (R2 = .187, p < .001). Significant independent predictors included Pain Self-Efficacy (β = -0.413, p < .001), Anxiety (β = 0.387, p = .003), and Pain Self-Management (β= 0.243, p = .011). Pain intensity became non-significant in final model (β= 0.143, p = .071).

Conclusions: Psychological factors—specifically pain self-efficacy and anxiety—emerged as more robust predictors of functional disability than pain intensity among outpatients at this Malaysian multidisciplinary clinic. Crucially, the initial predictive power of pain intensity was rendered non-significant once emotional distress and cognitive-behavioural variables—including self-management and coping strategies—were accounted for. This indicates that functional status is driven more by a patient’s confidence in managing pain and anxiety levels than by pain severity alone. Therefore, integrating targeted interventions to strengthen self-efficacy and address anxiety is essential for reducing disability and optimising functional outcomes within a multidisciplinary framework.

References: 1. IASP. (2020). IASP announces revised definition of pain. Washington, DC: International Association for the Study of Pain.
2. Turk, D. C., & Wilson, H. D. (2018). The biopsychosocial model of pain. In Handbook of Pain Management.
3. Ministry of Health Malaysia. (2022). Pain management handbook (3rd ed.). Putrajaya: MoH.
4. Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic pain: A state of the art. Pain, 85(3), 317–332. https://doi.org/10.1016/S0304-3959(99)00242-0
5. Nicholas, M. K. (2007). The pain self-efficacy questionnaire: Taking into account the pain. European Journal of Pain, 11(2), 153–163. https://doi.org/10.1016/j.ejpain.2005.12.008

Presenting Author: CHENG WAI SIM
Submitting Author: Cheng Wai Sim

Senior Author: CHENG WAI SIM

IASP 2026 Global Year theme of Neuropathic Pain: No