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Peer-reviewedCC BYEgyptian Journal of Health Care

Pain Self-Efficacy as a Mediator between Fear-Avoidance Beliefs and Social Avoidance among Individuals with Comorbid Post- Traumatic Stress Disorder and Chronic Pain

  • Nehal Sobhy Emaraa1
  • Abeer Taha Ahmed Taha2
  • Rania Sobhy Elgendy3
  1. 1Lecturer of Psychiatric & Mental Health Nursing, Faculty of Nursing-Menoufia University.
  2. 2Assistant Prof psychiatric mental health nursing, Faculty of Nursing, Cairo University, Egypt
  3. 3Lecturer of Psychiatric & Mental Health Nursing, Faculty of Nursing-Menoufia University
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Abstract

Background: Post-traumatic stress disorder (PTSD) and chronic pain frequently coexist, contributing to functional disability and social isolation. Aim: This study investigated whether pain self-efficacy mediates the relationship between fear-avoidance beliefs and social avoidance in individuals with comorbid PTSD and chronic pain. Methods: A descriptive correlational design was implemented. A purposive sample of 84 patients with chronic pain and comorbid PTSD was recruited from the Outpatient Pain Clinic of Menoufia University Hospital in Shebin El-Kom, Egypt. Data were collected using a structured interviewing questionnaire, completed validated self-report measures of the Fear-Avoidance Beliefs Questionnaire (FABQ), the Pain Self-Efficacy Questionnaire (PSEQ), Social Avoidance and Distress Scale (SADS), Posttraumatic Checklist for DSM-5 (PCL-5) and Visual Analogue Pain scale (VAS). Results: Lower pain self-efficacy was significantly predicted by fear-avoidance beliefs (β = -0.448, p <.001). Higher social avoidance and distress behavior were significantly correlated with lower pain self-efficacy (β = -0.564, p <.001). The indirect effect (a × b = 0.253) was statistically significant, as its 95% BCa bootstrap confidence interval [0.110, 0.461] did not cross zero, despite the fact that the total effect of fear-avoidance on social avoidance was significant (β = 0.379, p <.001). Demonstrating that the relationship between fear-avoidance beliefs and social avoidance is fully accounted for by pain self-efficacy. The final model accounted for 44.8% of the variance in social avoidance and distress behavior. Conclusion: Social avoidance in patients with comorbid PTSD and chronic pain is influenced by fear-avoidance beliefs, which are mediated by pain self-efficacy. Interventions that emphasize pain self-efficacy may mitigate social withdrawal and promote functional recovery. Recommendations: Psychiatric and pain-management nurses should integrate pain self-efficacy enhancement programs and cognitive-behavioral strategies into routine care to alleviate fear-avoidance beliefs and mitigate social isolation in this vulnerable population

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Cite

BibTeXRIS
BibTeX
@article{emaraa2026pain,
  title = {{Pain Self-Efficacy as a Mediator between Fear-Avoidance Beliefs and Social Avoidance among Individuals with Comorbid Post- Traumatic Stress Disorder and Chronic Pain}},
  author = {Nehal Sobhy Emaraa and Abeer Taha Ahmed Taha and Rania Sobhy Elgendy},
  journal = {Egyptian Journal of Health Care},
  year = {2026},
  month = sep,
  doi = {10.21608/ejhc.2026.534137},
  url = {https://doi.org/10.21608/ejhc.2026.534137},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Pain Self-Efficacy as a Mediator between Fear-Avoidance Beliefs and Social Avoidance among Individuals with Comorbid Post- Traumatic Stress Disorder and Chronic Pain
AU  - Nehal Sobhy Emaraa
AU  - Abeer Taha Ahmed Taha
AU  - Rania Sobhy Elgendy
PY  - 2026
DA  - 2026/09/01
JO  - Egyptian Journal of Health Care
DO  - 10.21608/ejhc.2026.534137
UR  - https://doi.org/10.21608/ejhc.2026.534137
AB  - Background: Post-traumatic stress disorder (PTSD) and chronic pain frequently coexist, contributing to functional disability and social isolation. Aim: This study investigated whether pain self-efficacy mediates the relationship between fear-avoidance beliefs and social avoidance in individuals with comorbid PTSD and chronic pain. Methods: A descriptive correlational design was implemented. A purposive sample of 84 patients with chronic pain and comorbid PTSD was recruited from the Outpatient Pain Clinic of Menoufia University Hospital in Shebin El-Kom, Egypt. Data were collected using a structured interviewing questionnaire, completed validated self-report measures of the Fear-Avoidance Beliefs Questionnaire (FABQ), the Pain Self-Efficacy Questionnaire (PSEQ), Social Avoidance and Distress Scale (SADS), Posttraumatic Checklist for DSM-5 (PCL-5) and Visual Analogue Pain scale (VAS). Results: Lower pain self-efficacy was significantly predicted by fear-avoidance beliefs (β = -0.448, p <.001). Higher social avoidance and distress behavior were significantly correlated with lower pain self-efficacy (β = -0.564, p <.001). The indirect effect (a × b = 0.253) was statistically significant, as its 95% BCa bootstrap confidence interval [0.110, 0.461] did not cross zero, despite the fact that the total effect of fear-avoidance on social avoidance was significant (β = 0.379, p <.001). Demonstrating that the relationship between fear-avoidance beliefs and social avoidance is fully accounted for by pain self-efficacy. The final model accounted for 44.8% of the variance in social avoidance and distress behavior. Conclusion: Social avoidance in patients with comorbid PTSD and chronic pain is influenced by fear-avoidance beliefs, which are mediated by pain self-efficacy. Interventions that emphasize pain self-efficacy may mitigate social withdrawal and promote functional recovery. Recommendations: Psychiatric and pain-management nurses should integrate pain self-efficacy enhancement programs and cognitive-behavioral strategies into routine care to alleviate fear-avoidance beliefs and mitigate social isolation in this vulnerable population
SN  - 3009-6766
SN  - 1687-9546
ER  -