The Relationship between Chronic Musculoskeletal Pain, Anxiety and Mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain

The Fear-Avoidance Model of Chronic Pain proposed by Vlaeyen and Linton in 2000 states individuals enter a cycle of chronic pain due to predisposing psychological factors, however they do not specify the nature of the psychological factors or propose a treatment method for chronic pain patients. This study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if 1) ruminative anxiety is a risk factor for developing chronic pain and 2) mindfulness is a potential treatment for breaking the cycle of chronic pain. Middle-aged adults ages 35-50 years (N=201) with self-reported CMP were recruited online. Using Qualtrics software, participants completed six standardized questionnaires assessing elements of chronic pain, anxiety, and mindfulness. Ruminative anxiety was positively correlated with pain catastrophizing, pain-related fear and avoidance, pain interference, and pain severity but negatively correlated with mindfulness. Mindfulness significantly predicted variance (R²) in five of the six multiple hierarchical regression analyses assessing chronic pain and anxiety outcomes. Pain severity, ruminative anxiety, pain catastrophizing, pain-related fear and avoidance, and mindfulness significantly predicted 70.0% of the variance in pain interference, with pain severity, ruminative anxiety and mindfulness being unique predictors. High ruminative anxiety level predicted significantly higher elements of chronic pain and significantly lower level of mindfulness. Moderated regressions indicated no significant interactions between mindfulness, ruminative anxiety, and elements of chronic pain. The present study provides additional insight into the relationships between ruminative anxiety, mindfulness and chronic pain, demonstrating that comorbid chronic pain and anxiety is associated with significantly decreased mindfulness. Given these findings, it is possible that ruminative anxiety should be added the Fear-Avoidance Model of Chronic Pain as a predisposing psychological risk factor and mindfulness should be added as a treatment strategy that can break the chronic pain cycle.