Acceptance versus catastrophizing in predicting quality of life in patients with chronic low back pain

  • Semeru, Gracia Mayuni (Department of Psychology, Atma Jaya Catholic University of Indonesia) ;
  • Halim, Magdalena S. (Department of Psychology, Atma Jaya Catholic University of Indonesia)
  • Received : 2018.07.25
  • Accepted : 2018.10.28
  • Published : 2019.01.01


Background: The aim of this study was to investigate the relationship between pain catastrophizing, acceptance, and quality of life in relation to chronic low back pain in Jakarta, the capital city of Indonesia. We also analyze the effect of personality in catastrophizing and acceptance. Methods: A total of 52 chronic low back pain patients were enrolled as participants from 2 hospitals in Jakarta (43 females, 9 males, mean age 54.38 years). Participants completed a set of self-reported questionnaires: the NEO Five Factor Inventory (NEO-FFI), Chronic Pain Acceptance Questionnaire-Revised (CPAQ-R), Pain Catastrophizing Scale (PCS), and Pain Discomfort Module (PDM). Results: This study showed that acceptance increased the patient's quality of life by giving physical relief from pain. In contrast, pain catastrophizing decreased the quality of life, and increased the patients' tendency to get frustrated, irritated, and anxious about the pain. From a personality perspective, the trait neuroticism may lead to a higher level of pain catastrophizing. Conclusions: This study showed that catastrophizing, compared with acceptance, had a greater impact on the patient's life by reducing its quality.


  1. Mason VL, Mathias B, Skevington SM. Accepting low back pain: is it related to a good quality of life? Clin J Pain 2008; 24: 22-9.
  2. National Institute of Neurological Disorders and Stroke (NINDS). Chronic pain information page [Internet]. Rockville (MD): NINDS; 2016 [cited 2017 Sep 20]. Available at
  3. Purwata TE, Sadeli HA, Yudiyanta Y, Anwar Y, Amir D, Asnawi C , et a l. C haracteristics o f neu ropathic p ain in Indonesia: a hospital based national clinical survey. Neurol Asia 2015; 20: 389-94.
  4. Amris K, Wæhrens EE, Jespersen A, Bliddal H, Danneskiold-Samsoe B. Observation-based assessment of functional ability in patients with chronic widespread pain: a crosssectional study. Pain 2011; 152: 2470-6.
  5. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10: 287-333.
  6. McBeth J, Nicholl BI, Cordingley L, Davies KA, Macfarlane GJ. Chronic widespread pain predicts physical inactivity: results from the prospective EPIFUND study. Eur J Pain 2010; 14: 972-9.
  7. Bentsen SB, Hanestad BR, Rustoen T, Wahl AK. Quality of life in chronic low back pain patients treated with instrumented fusion. J Clin Nurs 2008; 17: 2061-9.
  8. Doran NJ. Experiencing wellness within illness: exploring a mindfulness-based approach to chronic back pain. Qual Health Res 2014; 24: 749-60.
  9. Evers AW, Kraaimaat FW, van Lankveld W, Jongen PJ, Jacobs JW, B ijlsma JW. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J Consult Clin Psychol 2001; 69: 1026-36.
  10. McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain 2005; 118: 164-9.
  11. Poppe C, Crombez G, Devulder J, Hanoulle I, Vogelaers D, Petrovic M. Personality traits in chronic pain patients are associated with low acceptance and catastrophizing about pain. Acta Clin Belg 2011; 66: 209-15.
  12. Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009; 9: 745-58.
  13. Vowles KE, McCracken LM, Eccleston C. Processes of change i n treatment for c hronic p ain: t he c ontribu tions of pain, acceptance, and catastrophizing. Eur J Pain 2007; 11: 779-87.
  14. McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain 2003; 105: 197-204.
  15. McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain 2004; 107: 159-66.
  16. Viane I, Crombez G, Eccleston C, Poppe C, Devulder J, Van Houdenhove B, et al. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain 2003; 106: 65-72.
  17. Sturgeon JA, Zautra AJ. Psychological resilience, pain catastrophizing, and positive emotions: perspectives on comprehensive modeling of individual pain adaptation. Curr Pain Headache Rep 2013; 17: 317.
  18. Cecchi F, Molino-Lova R, Paperini A, Boni R, Castagnoli C, Gentile J, et al. Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up. Intern Emerg Med 2011; 6: 413-21.
  19. Rosenberg JC, Schultz DM, Duarte LE, Rosen SM, Raza A. Increased pain catastrophizing associated with lower pain relief during spinal cord stimulation: results from a large post-market study. Neuromodulation 2015; 18: 277-84.
  20. Smith AD, Jull GA, Schneider GM, Frizzell B, Hooper RA, Sterling MM. Low pain catastrophization and disability predict successful outcome to radiofrequency neurotomy in individuals with chronic whiplash. Pain Pract 2016; 16: 311-9.
  21. Walton DM, Macdermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013; 43: 31-43.
  22. Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 524-32.
  23. Elander J, Robinson G, Mitchell K, Morris J. An assessment of the relative influence of pain coping, negative thoughts about pain, and pain acceptance on health-related quality of life among people with hemophilia. Pain 2009; 145: 169-75.
  24. Poppe C, Crombez G, Hanoulle I, Vogelaers D, Petrovic M. Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality. Nephrol Dial Transplant 2013; 28: 116-21.
  25. McCrae RR, Costa PT. Personality in adulthood: a five-factor theory perspective. 2nd ed. New York, Guilford Press. 2003.
  26. American Chronic Pain Association. Resource guide to chronic pain management [Internet]. Rocklin (CA): American Chronic Pain Association, inc.; 2018 [cited 2018 Dec 31]. Available at
  27. Mason VL, Skevington SM, Osborn M. The quality of life of people in chronic pain: developing a pain and discomfort module for use with the WHOQOL. Psychol Health 2008; 23: 135-54.
  28. Costa PT, McCrae RR. Revised NEO personality inventory (NEO PI-R) and NEP five-factor inventory (NEO-FFI): professional manual. Odessa, Psychological Assessment Resources. 1992.
  29. McCracken LM, Eccleston C, Bell L. Clinical assessment of behavioral coping responses: preliminary results from a brief inventory. Eur J Pain 2005; 9: 69-78.
  30. Arovah NI. Dasar-dasar fisioterapipada cedera olahraga. Yogyakarta, FIK UNY. 2010.
  31. Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain 2001; 17: 165-72.
  32. Banozic A, Miljkovic A, Bras M, Puljak L, Kolcic I, Hayward C, et al. Neuroticism and pain catastrophizing aggravate response to pain in healthy adults: an experimental study. Korean J Pain 2018; 31: 16-26.
  33. Burger JM. Personality. Belmont, Thomson Wadsworth. 2004.
  34. Hajek A, Bock JO, Konig HH. The role of personality in health care use: results of a population-based longitudinal study in Germany. PLoS One 2017; 12: e0181716.
  35. Widiger TA, Oltmanns JR. Neuroticism is a fundamental domain of personality with enormous public health implications. World Psychiatry 2017; 16: 144-5.
  36. Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015; 49: 73.
  37. Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low back pain in US adults: data from the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68: 1688-94.
  38. Barbe MF, Gallagher S, Massicotte VS, Tytell M, Popoff SN, Barr-Gillespie AE. The interaction of force and repetition on musculoskeletal and neural tissue responses and sensorimotor behavior in a rat model of work-related musculoskeletal disorders. BMC Musculoskelet Disord 2013; 14: 303.
  39. Wang YXJ. Postmenopausal Chinese women show accelerated lumbar disc degeneration compared with Chinese men. J Orthop Translat 2015; 3: 205-11.
  40. Habib RR, El Zein K, Hojeij S. Hard work at home: musculoskeletal pain among female homemakers. Ergonomics 2012; 55: 201-11.
  41. Sari KP, Halim MS. Perbedaan kualitas hidup antara berbagai metode manajemen nyeri pada pasien nyeri kronis. J Psikol 2017; 44: 107-25.