Abstract
Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.
Similar content being viewed by others
References
Ahmed, S., Aggarwal, A., & Lawrence, A. (2019). Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatology International, 39(8), 1397–1403. https://doi.org/10.1007/s00296-019-04323-7.
Aldrich, S., Eccleston, C., & Crombez, G. (2000). Worrying about chronic pain: Vigilance to threat and misdirected problem solving. Behaviour Research and Therapy, 38(5), 457–470. https://doi.org/10.1016/S0005-7967(99)00062-5.
Andrews, N. E., Strong, J., & Meredith, J. P. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 93(11), 2109–2121. https://doi.org/10.1016/j.apmr.2012.05.029.
Arnold, L. M., Gebke, K. B., & Choy, E. H. (2016). Fibromyalgia: Management strategies for primary care providers. International Journal of Clinical Practice, 70, 99–112.
Ben-Yosef, M., Tanai, G., Buskila, D., Amital, D., & Amital, H. (2020). Fibromyalgia and its consequent disability. The Israel Medical Association Journal: IMAJ, 7(22), 380–384.
Birkholtz, M., Aylwin, L., & Harman, R. (2004). Activity pacing in chronic pain management: one aim, but which method? Part two: National activity pacing survey. British Journal of Occupational Therapy, 67, 481–487.
Burns, J. W., Van Dyke, B. P., Newman, A. K., Morais, C. A., & Thorn, B. E. (2020). Cognitive behavioral therapy (CBT) and pain education for people with chronic pain: Tests of treatment mechanisms. Journal of Consulting and Clinical Psychology, 88(11), 1008–1018. https://doi.org/10.1037/ccp0000612.
Campos, R. P., & Vázquez, M. I. (2013). The impact of fibromyalgia on health-related quality of life in patients according to age. Rheumatology International, 33(6), 1419–1424. https://doi.org/10.1007/s00296-012-2568-0.
Cane, D., McCarthy, M., & Mazmanian, D. (2016). Obstacles to activity pacing. Pain, 157(7), 1508–1514. https://doi.org/10.1097/j.pain.0000000000000553.
Cane, D., Nielson, W. R., McCarthy, M., & Mazmanian, D. (2013). Pain-related activity patterns: Measurement, interrelationships, and associations with psychosocial functioning. The Clinical journal of pain, 29(5), 435–442.
Carrillo-de-la-Peña, M. T., Triñanes, Y., González-Villar, A., Romero-Yuste, S., Gómez-Perretta, C., Arias, M., & Wolfe, F. (2015). Convergence between the 1990 and 2010 ACR diagnostic criteria and validation of the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ). Rheumatology International, 35(1), 141–151. https://doi.org/10.1007/s00296-014-3074-3.
Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311, 1547–1555.
Craner, J. R., Lake, E. S., Bancroft, K. A., & George, L. L. (2019). Treatment outcomes and mechanisms for an ACT-based 10-week interdisciplinary chronic pain rehabilitation program. Pain Practice, 20, 44–54. https://doi.org/10.1111/papr.12824.
Craner, J. R., Sperry, J. A., Koball, A. M., Morrison, E. J., & Gilliam, W. P. (2017). Unique contributions of acceptance and catastrophizing on chronic pain adaptation. International Journal of Behavioral Medicine, 24(4), 542–551. https://doi.org/10.1007/s12529-017-9646-3.
Cuperus, N., Vlieland, T., Brodin, N., Hammond, A., Kjeken, I., Lund, H., … van den Ende, C.H. (2015). Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care: Results of an international Delphi survey. Scandinavian Journal of Rheumatology, 45, 1–9.
Dahl, J., Kelly, G., Wilson, G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35(4), 785–801. https://doi.org/10.1016/S0005-7894(04)80020-0.
Damme, S. V., & Kindermans, H. (2015). A self-regulation perspective on avoidance and persistence behavior in chronic pain. The Clinical Journal of Pain, 31(2), 115–122. https://doi.org/10.1097/AJP.0000000000000096.
Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: A misdirected problem solving model. Pain, 132(3), 233–236. https://doi.org/10.1016/j.pain.2007.09.014.
Ecija, C., Catala, P., Sanroman, L., Lopez-Roig, S., Pastor-Mira, M. Á., & Peñacoba, C. (2020a). Is perfectionism always dysfunctional? Looking into its interaction with activity patterns in women with fibromyalgia. Clinical Nursing Research. https://doi.org/10.1177/1054773820973273.
Écija, C., Luque-Reca, O., Suso-Ribera, C., Catala, P., & Peñacoba, C. (2020b). Associations of cognitive fusion and pain catastrophizing with fibromyalgia impact through fatigue, pain severity, and depression: An exploratory study using structural equation modeling. Journal of Clinical Medicine, 9, 1763. https://doi.org/10.3390/jcm9061763.
Edwards, R. R., Cahalan, C., Mensing, G., Smith, M., & Haythornthwaite, J. A. (2011). Pain, catastrophizing, and depression in the rheumatic diseases. Nature Reviews Rheumatology, 7(4), 216–224. https://doi.org/10.1038/nrrheum.2011.2.
Esteve, R., López-Martínez, A. E., Peters, M. L., Serrano-Ibáñez, E. R., Ruíz-Párraga, G. T., González-Gómez, H., & Ramírez-Maestre, C. (2017). Activity pattern profiles: Relationship with affect, daily functioning, impairment, and variables related to life goals. The Journal of Pain, 18(5), 546–555. https://doi.org/10.1016/j.jpain.2016.12.013.
Esteve, R., Ramírez-Maestre, C., & López-Martínez, A. E. (2007). Adjustment to chronic pain: The role of pain acceptance, coping strategies, and pain-related cognitions. Annals of Behavioral Medicine, 33(2), 179–188. https://doi.org/10.1007/BF02879899.
Esteve, R., Ramírez-Maestre, C., Peters, M. L., Serrano-Ibáñez, E. R., Ruíz-Párraga, G. T., & López-Martínez, A. E. (2016). Development and initial validation of the activity patterns scale in patients with chronic pain. The Journal of Pain, 17(4), 451–461. https://doi.org/10.1016/j.jpain.2015.12.009.
Estévez-López, F., Álvarez-Gallardo, I. C., Segura-Jiménez, V., Soriano-Maldonado, A., Borges-Cosic, M., Pulido-Martos, M., … Geenen, R. (2018). The discordance between subjectively and objectively measured physical function in women with fibromyalgia: Association with catastrophizing and self-efficacy cognitions. The Al-Ándalus Project. Disability and Rehabilitation, 40(3), 329–337. https://doi.org/10.1080/09638288.2016.1258737.
Feldner, M. T., Hekmat, H., Zvolensky, M. J., Vowles, K. E., Secrist, Z., & Leen-Feldner, E. W. (2006). The role of experiential avoidance in acute pain tolerance: A laboratory test. Journal of Behavior Therapy and Experimental Psychiatry, 37(2), 146–158. https://doi.org/10.1016/j.jbtep.2005.03.002.
García Campayo, J., Rodero, B., Alda, M., Sobradiel, N., Montero, J., & Moreno, S. (2008). Validation of the Spanish version of the pain catastrophizing scale in fibromyalgia. Medicina Clínica, 131(13), 487–492.
Gill, J. R., & Brown, C. A. (2009). A structured review of the evidence for pacing as a chronic pain intervention. European Journal of Pain, 13, 214–216.
Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60(1), 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530.
Gyurcsik, N. C., Lawrence, R., Brawley, K. S., Spink, K., Glazebrook, E., & Anderson, T. J. (2011). Is level of pain acceptance differentially related to social cognitions and behavior? The case of active women with arthritis. Journal of Health Psychology, 16(3), 530–539. https://doi.org/10.1177/1359105310394229.
Hadzic, R., Sharpe, L., Wood, B., & MacCann, C. (2019). The non-avoidant pacing scale: Development and preliminary validation. The Journal of Pain, 20, 224–234. https://doi.org/10.1016/j.jpain.2018.09.006.
Hasenbring, M. I., Hallner, D., & Rusu, A. C. (2009). Fear-avoidance- and endurance-related responses to pain: Development and Validation of the Avoidance-Endurance Questionnaire (AEQ). European Journal of Pain, 13(6), 620–628. https://doi.org/10.1016/j.ejpain.2008.11.001.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York: Guilford Press.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis second edition a regression-based approach. New York: Guilford Press.
Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. H. (2003). Contemporary behavioral activation treatments for depression: Procedures, principles and progress. Clinical Psychology Review, 23, 699–717. https://doi.org/10.1016/S0272-7358(03)00070-9.
Jamieson-Lega, K., Berry, R., & Brown, C. A. (2013). Pacing: A concept analysis of the chronic pain intervention. Pain Research & Management, 18, 207–213.
Jensen, M. P., Turner, L. R., Turner, J. A., & Romano, J. M. (1996). The use of multiple-item scales for pain intensity measurement in chronic pain patients. Pain, 67(1), 35–40.
Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. Behavior Analyst, 29, 161–185.
Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: Current state of the science. The Journal of Pain, 5(4), 195–211. https://doi.org/10.1016/j.jpain.2004.02.576.
Kindermans, H., Roelofs, P. J., Goossens, M. E. J. B., Huijnen, I. J. P., Verbunt, J. A., & Vlaeyen, J. W. S. (2011). Activity patterns in chronic pain: Underlying dimensions and associations with disability and depressed mood. The Journal of Pain, 12(10), 1049–1058. https://doi.org/10.1016/j.jpain.2011.04.009.
Lami, M. J., Martínez, M. P., Miró, E., Sánchez, A. I., & Guzmán, M. A. (2018). Catastrophizing, acceptance, and coping as mediators between pain and emotional distress and disability in fibromyalgia. Journal of Clinical Psychology in Medical Settings, 25(1), 80–92. https://doi.org/10.1007/s10880-018-9543-1.
Lee, J. W., Lee, K. E., Park, D. J., Kim, S. H., Nah, S. S., Lee, J. H., et al. (2017). Determinants of quality of life in patients with fibromyalgia: A structural equation modeling approach. Edited by John A. Sturgeon. PLoS ONE, 12(2), e0171186. https://doi.org/10.1371/journal.pone.0171186.
Luthi, F., Vuistiner, P., Favre, C., Hilfiker, R., & Léger, B. (2018). Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses. PLoS ONE, 13(9), 1–23. https://doi.org/10.1371/journal.pone.0203329.
Masedo, A. I., & Esteve, R. (2000). Some empirical evidence regarding the validity of the Spanish Version of the McGill Pain Questionnaire (MPQ-SV). Pain, 85(3), 451–456. https://doi.org/10.1016/S0304-3959(99)00300-0.
Mazzucchelli, T. G., & Da Silva, M. (2016). The potential of behavioural activation for the treatment of chronic pain: An exploratory review. Journal of Clinical Psychology, 20, 5–16. https://doi.org/10.1111/cp.12088.
McCracken, L. M. (2005). Contextual cognitive-behavioral therapy for pain. In: Progress in pain research and management. Philadelphia: IASP Press.
McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain? Pain, 105(1-2), 197–204.
McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221–234.
McCracken, L. M., Patel, S., & Scott, W. (2018). The role of psychological flexibility in relation to suicidal thinking in chronic pain. European Journal of Pain, 22(10), 1774–1781. https://doi.org/10.1002/ejp.1273.
McCracken, L. M., & Samuel, V. M. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain, 130(1), 119–125. https://doi.org/10.1016/j.pain.2006.11.016.
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69, 178–187. https://doi.org/10.1037/a00356.
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107(1), 159–166. https://doi.org/10.1016/j.pain.2003.10.012.
McCracken, L. M., Vowles, K. E., & Zhao-O’Brien, J. (2010). Further development of an instrument to assess psychological flexibility in people with chronic pain. Journal of Behavioral Medicine, 33, 346–354.
McCracken, L. M., & Yang, S. Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123(1), 137–145. https://doi.org/10.1016/j.pain.2006.02.021.
Molton, I. R., Jensen, M. P., Nielson, W., Cardenas, D., & Ehde, D. M. (2008). A preliminary evaluation of the motivational model of pain self-management in persons with spinal cord injury-related pain. The Journal of Pain, 9, 606–612. https://doi.org/10.1016/j.jpain.2008.01.338.
Moon, H. M. (2006). Development and validation of the program for facilitation of psychological acceptance based on Acceptance and Commitment Therapy model. Unpublished doctoral dissertation.
Murphy, S. L., Smith, D. M., & Alexander, N. B. (2008). Measuring activity pacing in women with lower-extremity osteoarthritis: A pilot study. American Journal of Occupational Therapy, 62(3), 329–334. https://doi.org/10.5014/ajot.62.3.329.
Nielson, W. R., Jensen, M. P., & Hill, M. L. (2001). An activity pacing scale for the chronic pain coping inventory: Development in a sample of patients with fibromyalgia syndrome. Pain, 89, 111–115. https://doi.org/10.1016/S0304-3959(00)00351-1.
Nielson, W. R., Jensen, M. P., Karsdorp, P. A., & Vlaeyen, J. W. S. (2013a). A content analysis of activity pacing in chronic pain. The Clinical Journal of Pain. https://doi.org/10.1097/AJP.0000000000000024.
Nielson, W., Jensen, M. P., & Vlaeyen, J. W. (2013b). Activity pacing in chronic pain: concepts, evidence and future directions. Clinical Journal of Pain, 29, 461–468.
Peres, M. F. P., & Lucchetti, G. (2010). Coping strategies in chronic pain. Current Pain and Headache Reports, 14(5), 331–338. https://doi.org/10.1007/s11916-010-0137-3.
Pulido-Martos, M., Luque-Reca, O., Segura-Jiménez, V., Álvarez-Gallardo, I. C., Soriano-Maldonado, A., Acosta-Manzano, P., et al. (2020). Physical and psychological paths toward less severe fibromyalgia: A structural equation model. Annals of Physical and Rehabilitation Medicine, 63(1), 46–52. https://doi.org/10.1016/j.rehab.2019.06.017.
Quartana, P. J., Campbell, C. M., & Edwards, R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9(5), 745–758. https://doi.org/10.1586/ern.09.34.
Racine, M., Galán, S., De La Vega, R., Tome Pires, C., Solé, E., Nielson, W. R., … Jense, M. P. (2018). Pain-related activity management patterns and function in patients with fibromyalgia syndrome. Clinical Journal of Pain, 34(2), 122–129. https://doi.org/10.1097/AJP.0000000000000526.
Rankin, H., & Holttum, S. E. (2003). The Relationship between Acceptance and Cognitive Representations of Pain in Participants of a Pain Management Programme. Psychology, Health & Medicine, 8(3), 329–334. https://doi.org/10.1080/1354850031000135768.
Sullivan, M. J. L., Adams, H., & Ellis, T. (2012). Targeting catastrophic thinking to promote return to work in individuals with fibromyalgia. Journal of Cognitive Psychotherapy, 26(2), 130–142. https://doi.org/10.1891/0889-8391.26.2.130.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524.
Suso-Ribera, C., Camacho-Guerrero, L., McCracken, L. M., Maydeu-Olivares, A., & Gallardo-Pujol, D. (2016). Social problem solving in chronic pain: An integrative model of coping predicts mental health in chronic pain patients. Journal of Health Psychology, 21(6), 1015–1025. https://doi.org/10.1177/1359105314544133.
Suso-Ribera, C., Camacho-Guerrero, L., Osma, J., Suso-Vergara, S., & Gallardo-Pujol, D. (2019). A reduction in pain intensity is more strongly associated with improved physical functioning in frustration tolerant individuals: A longitudinal moderation study in chronic pain patients. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2019.00907.
Suso-Ribera, C., Catalá, P., Ecija, C., et al. (2020). Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia. European Journal of Pain. https://doi.org/10.1002/ejp.1669.
Tan, G., Teo, I., Anderson, K. O., & Jensen, M. P. (2011). Adaptive versus maladaptive coping and beliefs and their relation to chronic pain adjustment. Clinical Journal of Pain, 27, 769–774. https://doi.org/10.1097/AJP.0b013e31821d8f5a.
Thompson, M., & McCracken, L. M. (2011). Acceptance and related processes in adjustment to chronic pain. Current Pain and Headache Reports, 15(2), 144–151. https://doi.org/10.1007/s11916-010-0170-2.
Turk, D. C., Swanson, K. S., & Tunks, E. R. (2008). Psychological approaches in the treatment of chronic pain patients—When pills, scalpels, and needles are not enough. The Canadian Journal of Psychiatry, 53(4), 213–223. https://doi.org/10.1177/070674370805300402.
Viane, I., Crombez, G., Eccleston, C., Devulder, J., & De Corte, W. (2004). Acceptance of the unpleasant reality of chronic pain: Effects upon attention to pain and engagement with daily activities. Pain, 112(3), 282–288. https://doi.org/10.1016/j.pain.2004.09.008.
Vlaeyen, J. W. S., & Steven, L. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. https://doi.org/10.1016/S0304-3959(99)00242-0.
Wilgen, C. P., Van Ittersum, M. W., Kaptein, A. A., & Van Wijhe, M. (2008). Illness perceptions in patients with fibromyalgia and their relationship to quality of life and catastrophizing. Arthritis & Rheumatism, 58(11), 3618–3626. https://doi.org/10.1002/art.23959.
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007407.pub3.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., … Yunus, M. B. (2010). The American College of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research, 62(5), 600–610. https://doi.org/10.1002/acr.20140.
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., … Tugwell. O. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism, 33(2), 160–172. https://doi.org/10.1016/j.pain.2008.02.009.
Wolfe, F., Walitt, B. T., Katz, R. S., & Häuser, W. (2014). Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia Edited by Shervin Assassi. PLoS ONE, 9(2), e88740. https://doi.org/10.1371/journal.pone.0088740.
Yu, L., Norton, S., & McCracken, L. M. (2017). Change in ‘self-as-context’ (‘perspective-taking’) occurs in acceptance and commitment therapy for people with chronic pain and is associated with improved functioning. The Journal of Pain, 18(6), 664–672. https://doi.org/10.1016/j.jpain.2017.01.005.
Acknowledgements
The authors gratefully acknowledge all the participants for their collaboration and enthusiasm.
Funding
This work was funded by the Health Research Fund (Fondo de Investigación en Salud), Grant Number PI17/00858 from the Instituto de Salud Carlos III (Spain) co-financed by the European Union through the Fondo Europeo de Desarrollo Regional (FEDER). 2University Professors. PhD, Psychology’s contribution was supported by a research Grant from MINECO (PSI2016-79566-C2-1-R).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CP, CE, and PC. The first draft of the manuscript was written by CE, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. CE: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing—original draft, Writing review and editing. CP: Conceptualization, data curation, Investigation, Methodology, Resources Writing—original draft, supervision, validation. Funding acquisition. PC: Conceptualization, methodology, resources, data curation; writing—original draft preparation. SL-R: Conceptualization, resources, data curation, writing—original draft preparation. Her contribution was supported by a research grant from MINECO (PSI2016-79566-C2-1-R). MAPM: Conceptualization, resources, data curation, writing—original draft preparation. Her contribution was supported by a research grant from MINECO (PSI2016-79566-C2-1-R). CG: Conceptualization, methodology, resources, data curation; writing—original draft preparation.
Corresponding author
Ethics declarations
Conflict of interest
Carmen Ecija, Patricia Catala, Sofía López-Roig, María Ángeles Pastor-Mira, Carmen Gallardo, Cecilia Peñacoba declares that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of Rey Juan Carlos University (Reference PI17/00858).
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Human and Animal Rights and Informed Consent
The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Rey Juan Carlos University; Reference PI17/00858).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ecija, C., Catala, P., López-Roig, S. et al. Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia. J Clin Psychol Med Settings 28, 734–745 (2021). https://doi.org/10.1007/s10880-021-09762-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-021-09762-8