Pain knowledge at treatment entry and post-treatment kinesiophobia in patients with fibromyalgia: a longitudinal study

BACKGROUND: Patients' understanding of pain mechanisms is recognized as a significant factor associated with clinical outcomes. However, relatively little research has explored the impact of patients' post-boosting baseline pain knowledge, beliefs and attitudes on subsequent treatment outcomes. Filling this gap could facilitate informed decision-making at an early stage of intervention. OBJECTIVE: This study aims to examine the relationship between baseline pain knowledge, beliefs and attitudes and clinical health outcomes, including kinesiophobia, following a multidisciplinary rehabilitation program. It was hypothesized that baseline understanding more aligned with contemporary scientific understanding would be associated with improved post-treatment health outcomes, even after controlling for initial health status. METHODS: A total of 330 participants with fibromyalgia were recruited from a Central Sensitivity Syndromes Specialized Unit. Pain knowledge was assessed using the PACKA questionnaire after a brief educational boosting intervention and prior to participation in a three-month multidisciplinary rehabilitation program including physical exercise, psychological intervention, and further pain education. Health-related variables were measured both before and after the intervention to analyze potential associations between post-boosting baseline pain knowledge and post-treatment health outcomes. RESULTS: After controlling for baseline health outcome scores, higher post-boosting baseline pain knowledge was significantly associated with lower post-treatment kinesiophobia (β = -0.23, 95% CI -0.35 to -0.12, p < 0.001). No significant associations were observed between post-boosting baseline pain knowledge and post-treatment fibromyalgia impact, anxiety, depression, or physical functioning (although the association was positive but non-significant). CONCLUSION: These findings partially support the initial hypothesis, indicating that higher levels of pain-related knowledge at treatment entry are associated with lower post-treatment kinesiophobia following the intervention, while accounting for initial health status, specifically for kinesiophobia.