Self-reported acceptable pain intensity is associated with psychosocial burden beyond pain severity in chronic pain patients: a cross-sectional study

Abstract Background Self-reported acceptable pain intensity is collected as part of intake procedures in some pain clinic settings, yet has rarely been examined in relation to psychosocial outcomes. This study investigated whether acceptable pain intensity is associated with psychosocial symptom burden (somatization, anxiety, sleep impairment, perceived stress, depression, and pain-related disability) in chronic pain patients after adjusting for pain severity and trauma history. Methods Secondary analysis of 822 chronic pain patients from a German university pain clinic (previously published cohort). Acceptable pain (visual analogue scale [VAS], 0-100) was examined in relation to somatization (PHQ-15), anxiety (GAD-7), sleep impairment (VAS), perceived stress (PHQ-Stress), depression (PHQ-9), and disability (Pain Disability Index) in multivariable regression models adjusted for three pain intensity measures, trauma category, age, and sex. Acceptable pain was scaled per 10-point VAS increment. Bonferroni correction was applied (α = 0.008). Post-hoc trauma × acceptable pain interactions were tested. Results Higher acceptable pain was associated with greater somatization (B = 0.37, 95% CI 0.19–0.55, p < .001), anxiety (B = 0.30, 0.11–0.48, p = .002), sleep impairment (B = 1.75, 0.67–2.84, p = .002), and perceived stress (B = 0.23, 0.09–0.37, p = .002), but not with depression ( p = .054) or disability ( p = .82). Findings were consistent across three prespecified sensitivity analyses. An exploratory post-hoc interaction test suggested that the acceptable pain-depression association was more pronounced in higher trauma categories (Bonferroni-significant trauma × acceptable pain interaction, p < .001). Conclusions Higher self-reported acceptable pain intensity is associated with elevated psychosocial symptom burden beyond pain severity, with significant adjusted associations for somatization, anxiety, sleep impairment, and perceived stress, but not for depression or disability. Although the incremental contribution was small, the direction of the association was consistent across the four significant outcomes. Higher acceptable pain should therefore not be interpreted as evidence of better coping. Instead, it may reflect heterogeneous processes such as low outcome expectations, resigned tolerability, or psychosocial vulnerability, particularly among patients in higher trauma categories; shared method variance cannot be excluded. Prospective validation is needed.