Are mindfulness skills associated with reducing kinesiophobia, pain severity, pain catastrophizing and physical disability? Results of Iranian patients with chronic musculoskeletal pain
More details
Hide details
Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran
Submission date: 2019-01-04
Final revision date: 2019-03-17
Acceptance date: 2019-03-18
Online publication date: 2019-04-29
Publication date: 2019-04-29
Health Psychology Report 2019;7(4):276–285
Although the results obtained for mindfulness-based treatments are promising, there is limited information concerning the role of different dimensions of mindfulness in the undesirable outcomes related to chronic pain such as physical pain and catastrophizing, pain severity, kinesiophobia and disability. Therefore, the objective of this present research was to examine the relationship between facets of mindfulness and the mentioned outcomes in individuals with musculoskeletal pain (MSP), including an extensive population of patients.

Participants and procedure:
In a cross-sectional research, 200 patients with chronic MSP were selected from northern Iran by the consecu-tive sampling method and were assessed through the Five Facet Mindfulness Questionnaire (FFMQ), Visual Analogue Scale (VAS), 24-item Roland Morris Disability Questionnaire (RMDQ-24), 17-item Tampa Scale of Kinesiophobia (TSK-17), and the Coping Strategies Questionnaire – Catastrophizing subscale (CSQ-CAT).

Results were obtained via multivariate hierarchical regression analyses after adjusting for the effects of demo-graphic variables, revealing that higher scores in the Observing subscale can predict lower scores in the VAS. Moreover, higher scores in the Describing subscale predict higher scores in VAS, CSQ-CAT and TSK-17; higher scores in Acting with Awareness predict lower scores in VAS and CSQ-CAT; higher scores in Non-judging pre-dict lower scores in VAS, RMDQ-24 and TSK-17; finally, higher scores in Non-reactivity predict higher scores in RMDQ-24 and TSK-17.

All factors existing in mindfulness are associated to MSP after controlling for certain undesirable outcomes. It seems that mindfulness interventions can potentially result in clinical improvement of patients suffering from chronic musculoskeletal pain.

Afshar-Nezhad, T., Rezaei, S., & Yousef-zadeh, S. (2010). The Relationship between Fear of Move-ment and Pain Intensity with Physical Disability in Chronic Low-Back Pain Patients. Journal of Re-habilitation, 11, 21–28. Retrieved from
Ahmadvand, Z., & Heydarinasab, L. (2013). An investigation of the validity and reliability of psycho-metric characteristics of five facet mindfulness questionnaire in Iranian non-clinical samples. Jour-nal of Behavioral Sciences, 7, 229–237. Retrieved from
Asgharimoghaddam, M. A. (2004). Evaluation prevalence of continuing and recurrent chronic pain and its effect on social function and life of workers in the one of Tehran’s big industry. Daneshvar Raf-tar, 4, 1–14. Retrieved from
Asgharimoghaddam, M., Golak, N. (2005). The role of coping strategies with pain in adjustment with chronic pain. Daneshvar Raftar, 1, 1–23. Retrieved from
Azad Marzabadi, E. & Hashemi Zadeh, S. M. (2014). The effectiveness of mindfulness training in im-proving the quality of life of the war victims with post-traumatic stress disorder (PTSD). Iranian Journal of Psychiatry, 9, 228–236.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assess-ment methods to explore facets of mindfulness. Assessment, 13, 27–45.
Beks, R. B., Mellema, J. J., Menendez, M. E., Chen, N. C., Ring, D., & Vranceanu, A. M. (2017). Does mindfulness correlate with physical function and pain intensity in patients with upper extremity ill-ness? Hand, 13, 237–243.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2006). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.
Braams, B. R., Blechert, J., Boden, M. T., & Gross, J. J. (2012). The effects of acceptance and sup-pression on anticipation and receipt of painful stimulation. Journal of Behavior Therapy and Experi-mental Psychiatry, 43, 1014–1018.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psy-chological well-being. Journal of Personality and Social Psychology, 84, 822–848.
Carmody, J., & Baer, R. A. (2007). Relationships between mindfulness practice and levels of mindful-ness, medical and psychological symptoms and well-being in a mindfulness-based stress reduc-tion program. Journal of Behavioral Medicine, 31, 23–33.
Coakes, S., Steed, L., & Ong, C. (2010). SPSS without anguish. Milton, QLD: Wiley.
Dehghani, M., Esmaeilian, N., Akbari, F., Hassanband, M., & Nikmanesh, E. (2014). Evaluating the psychometric and factorial structure of the five dimensional mindfulness questionnaire. Thoughts and Behavior in Clinical Psychology, 9, 77–86. Retrieved from
Falkenström, F. (2010). Studying mindfulness in experienced meditators: A quasi-experimental ap-proach. Personality and Individual Differences, 48, 305–331.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.
Gardner-Nix, J. (2009). Mindfulness-Based Stress Reduction for Chronic Pain Management. In F. Didonna (Ed.), Clinical Handbook of Mindfulness (pp. 369–381). New York, NY: Springer.
Gefen, D., Straub, D. W., & Boudreau, M. C. (2000). Structural equation modeling and regression: Guidelines for research and practice. Communications of the Association for Information Systems, 3, 1–78.
Gutke, A., Lundberg, M., Östgaard, H. C., & Öberg, B. (2010). Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depres-sive symptoms. European Spine Journal, 20, 440–448.
Harvey, A. M. (1995). Classification of chronic pain – descriptions of chronic pain syndromes and definitions of pain terms. The Clinical Journal of Pain, 11, 163.
Henriksson, J., Wasara, E., & Rönnlund, M. (2016). Effects of Eight-Week-Web-Based Mindfulness Training on Pain Intensity, Pain Acceptance, and Life Satisfaction in Individuals with Chronic Pain. Psychological Reports, 119, 586–607.
Herndon, F. (2008). Testing mindfulness with perceptual and cognitive factors: External vs. internal encoding, and the cognitive failures questionnaire. Personality and Individual Differences, 44, 32–41.
Jafari, H., Ebrahimi, I., Salavati, M., Kamali, M., & Fata, L. (2010). Psychometric properties of Iranian version of Tampa Scale for Kinesiophobia in low back pain patients. Archives of Rehabilitation, 11. Retrieved from
Jay, K., Brandt, M., Jakobsen, M. D., Sundstrup, E., Berthelsen, K. G., Schraefel, M. C., Sjøgaard, G., & Andersen, L. L. (2016). Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity. Medicine, 95, e3945.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte Press.
Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta.
Kabat-Zinn, J., Lipworth, L., Burney, R., & Sellers, W. (1986). Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clini-cal Journal of Pain, 2, 159–173.
Keefe, F. J., & Williams, D. A. (1990). A comparison of coping strategies in chronic pain patients in different age groups. Journal of Gerontology, 45, 161–165.
Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S., Schubiner, H., & Keefe, F. J. (2011). Pain and emotion: a biopsychosocial review of recent research. Journal of Clinical Psychology, 67, 942–968.
Mantzios, M., & Egan, H. (2018). An exploratory examination of mindfulness, self-compassion, and mindful eating in relation to motivations to eat palatable foods and BMI. Health Psychology Report, 6, 207–215.
Mousavi, S. J., Parnianpour, M., Mehdian, H., Montazeri, A., & Mobini, B. (2006). The Oswestry Disa-bility Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions. Spine, 31, E454–E459.
Ogon, M., Krismer, M., Söllner, W., Kantner-Rumplmair, W., & Lampe, A. (1996). Chronic low back pain measurement with visual analogue scales in different settings. Pain, 64, 425–428.
Otis, J. D. (2007). Managing Chronic Pain: Therapist Guide. Oxford, NY: Oxford University Press.
Poulin, P. A., Romanow, H. C., Rahbari, N., Small, R., Smyth, C. E., Hatchard, T., Solomon, B. K., Song, X., Harris, C. A., Kowal, J., Nathan, H. J., & Wilson, K. G. (2016). The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer sur-vivors living with chronic neuropathic pain. Supportive Care in Cancer, 24, 4167–4175.
Rezaei, S., Afsharnejad, T., Kafi, M., Soltani, R., & Fallahkohan, S. (2009). Relationship between de-pression and coping strategies in chronic back pain patients. Daneshvar Medicine, 16, 63–74. Re-trieved from
Roland, M., & Fairbank, J. (2000). The Roland-Morris Disability Questionnaire and the Oswestry Disa-bility Questionnaire. Spine, 25, 3115–3124.
Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain pa-tients: Relationship to patient characteristics and current adjustment. Pain, 17, 33–44.
Sanders, W. A., & Lam, D. H. (2010). Ruminative and mindful self-focused processing modes and their impact on problem solving in dysphoric individuals. Behaviour Research and Therapy, 48, 747–753.
Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain catastrophiz-ing in a fear-avoidance model of chronic pain. Pain, 148, 120–127.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for de-pression. New York: Guilford Press.
Sengupta, S., & Kumar, D. (2005). Pain and emotion: relationship revisited. German Journal of Psy-chiatry, 8, 85–93.
Siegel, R. D. (2010). The mindfulness solution: Everyday practices for everyday problems. New York: Guilford Press.
Smolen, J. S. (2004). Combating the burden of musculoskeletal conditions. Annals of the Rheumatic Diseases, 63, 329–329.
Taylor, W. J., Dean, S. G., & Siegert, R. J. (2006). Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskele-tal pain in a cross-sectional general adult population survey. Pain, 125, 225–232.
Thorn, B. E. (2017). Cognitive therapy for chronic pain: A step-by-step guide. New York: Guilford Press.
Turk, D. C., & Melzack, R. (2001). Handbook of pain assessment (2nd ed.). New York: Guilford Press.
Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Rotteveel, A. M., Ruesink, R., & Heuts, P. H. (1995). The role of fear of movement/(re)injury in pain disability. Journal of Occupational Rehabilitation, 5, 235–252.
Walker, B. F. (2000). The prevalence of low back pain: A systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders, 13, 205–217.