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Global Jou nal o Resea ch in Humani ies & Cul u al S udies
ISSN: 2583-2670 (Online)
Volume 05 | Issue 05 | Sep .-Oc . | 2025
Jou nal homepage: h ps://gj publica ion.com/gj hcs/
Resea ch A icle
The Rela ionship Be ween Emo ion Regula ion S a egies and Li es yle wi h Pain Se e i y in
Pa ien s wi h Ch onic Musculoskele al Pain in Pain Clinics o Mashhad
*Ali E ani Sayya 1, Ma yam Sada Mo e alli 2
1 M.A. in Clinical Psychology, Facul y o Medicine, Depa men o Psychology, Islamic Azad Uni e si y, Teh an
Medical Sciences B anch, Teh an, I an.
2 M.D., MPH, Facul y Membe and Dean o he Facul y o Public Heal h and Biomedical Enginee ing, Islamic Azad
Uni e si y, Teh an Medical Sciences B anch, Teh an, I an.
*Co esponding au ho : Ali E ani Sayya
M.A. in Clinical Psychology, Facul y o Medicine, Depa men o Psychology, Islamic Azad Uni e si y, Teh an Medical
Sciences B anch, Teh an, I an.
In oduc ion
Ch onic skele al pain diso de is a p e alen condi ion in which indi iduals epo se e e and pe sis en ch onic pain,
p ima ily localized o he skele al and muscula egions. This diso de can nega i ely impac quali y o li e, wo k
capaci y, and social ela ionships, o en leading o s ess, anxie y, and dep ession. Pa ien s wi h ch onic skele al pain
diso de equen ly su e om inc eased pain sensi i i y, ch onic a igue, and impai ed unc ionali y. The e ec i e
diagnosis and ea men o his complex condi ion emain challenging and equi e a ange o he apeu ic app oaches,
including pha maco he apy, psycho he apy, physio he apy, and su gical in e en ions (McPa land e al., 2021).
The p e alence o ch onic pain is inc easing wo ldwide, wi h app oxima ely 25% o ch onic pain pa ien s expe iencing
symp oms beyond pain, such as dep ession and anxie y, leading o ch onic pain synd ome. Ch onic pain a ec s mul iple
aspec s o an indi idual’s li e, including emo ional, in e pe sonal, occupa ional, and physical unc ioning, while imposing
Abs ac
The p esen s udy aimed o in es iga e he ela ionship be ween beha io al emo ion egula ion and li es yle wi h
pain in ensi y in pa ien s wi h ch onic skele al pain diso de a ending pain clinics in Mashhad. The s udy
employed a desc ip i e-co ela ional esea ch design. Bo h ield me hods (ques ionnai es) and lib a y esea ch
(books and a icles) we e used o da a collec ion. Addi ionally, he s udy is applied in na u e, as i s indings can
be used o imp o e he s a us o he examined a iables.
The s a is ical popula ion consis ed o all pa ien s who we e diagnosed wi h ch onic skele al pain diso de by
physicians and e e ed o pain clinics in Mashhad du ing he second qua e o 2023. Due o he inabili y o
p ecisely coun he popula ion size, he sample size was es ima ed using he Tabachnick and Fidell o mula (2007).
Acco dingly, a sample o 160 pa icipan s was selec ed using con enience sampling.
Da a we e collec ed using he Beha io al Emo ion Regula ion Ques ionnai e by C aig and Ga ne ski (2019), he
Li es yle Ques ionnai e by Ke n e al. (1997), and he McGill Pain Ques ionnai e (2009). Based on he esul s o
he co ela ion es , he e was a signi ican posi i e ela ionship be ween wi hd awal and pain in ensi y ( = 0.168)
and be ween igno ing and pain in ensi y ( = 0.159). Fu he mo e, a signi ican nega i e ela ionship was ound
be ween coping and pain in ensi y ( = -0.190), while a signi ican posi i e ela ionship was obse ed be ween
cau iousness and pain in ensi y ( = 0.202).
Keywo ds: Beha io al Emo ion Regula ion, Li es yle, Pain In ensi y, Pa ien s wi h Ch onic Skele al Pain
Diso de .
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subs an ial economic and heal hca e bu dens on socie y (Rawa e al., 2019). Ch onic pain signi ican ly in luences
pa ien s’ daily li es, whe e he deg ee o i s impac is closely ied o he pe cei ed in ensi y o pain (Ga ens e al., 2022).
Pain in ensi y esul s om a complex in e ac ion be ween pain s imuli and a ious cogni i e and emo ional ac o s.
Ch onic pain is ecognized as a majo public heal h issue, con ibu ing o signi ican social and economic bu dens.
Beyond a ec ing pa ien s as a senso y and emo ional challenge, pain in ensi y also in luences hei amilies. The
se e i y, du a ion, o loca ion o pain can ha e a p o ound e ec on physical unc ioning, educing physical ac i i y and
po en ially leading o disabili y. This, in u n, impac s o he aspec s o daily li e (Zanini e al., 2018). Pa ien s o en
desc ibe he ex ensi e consequences o pain in ensi y, such as a loss o enjoymen in li e, educed emo ional well-being,
a igue, weakness, and sleep dis u bances. Fu he mo e, eac i e psychological symp oms like dep ession and anxie y
may play a signi ican ole in de e mining pain in ensi y (Kim e al., 2021). Highligh ing he impo ance o pain in ensi y
is essen ial, as pa ien s wi h ch onic pain may endu e ex emely high le els o pain. To add ess hese challenges,
heal hca e p o essionals inc easingly adop comp ehensi e biopsychosocial amewo ks o examine and manage ac o s
ela ed o pain in ensi y (Hilme e al., 2021).
In his con ex , a s udy conduc ed by Russell and Pa k (2018) iden i ied beha io al emo ion egula ion as one o he key
ac o s in luencing pain in ensi y. Beha io al emo ion egula ion e e s o he ongoing p ocesses indi iduals employ o
manage and modi y hei emo ional esponses, including enhancing, supp essing, acili a ing, o dis up ing hei
emo ional exp essions (So wa d e al., 2021). I in ol es e o s o manage, adjus , o change emo ional eac ions and
emo ional beha io s. Beha io al emo ion egula ion consis s o i e dis inc subscales, each wi h ou i ems, ep esen ing
indi iduals' ac ions a e encoun e ing s ess ul e en s. These subscales include dis ac ion, wi hd awal, ac i e coping,
seeking social suppo , and igno ing (English e al., 2021).
The abili y o egula e emo ions allows indi iduals o u ilize app op ia e s a egies when con on ing po en ially
dis essing si ua ions. Emo ion egula ion, as a cogni i e p ocess, enables indi iduals o con ol how hey expe ience and
exp ess emo ions. Those wi h be e emo ion egula ion skills demons a e enhanced abili ies in social in e ac ions and
p oblem-sol ing. Fu he mo e, his capabili y can signi ican ly educe s ess and anxie y, ensu ing imp o ed quali y o
li e (Malagoli e al., 2021). E ec i e emo ion egula ion has been p oposed as a use ul s a egy o alle ia e pain in ensi y,
as indi iduals capable o managing nega i e emo ions ela ed o ch onic pain a e likely o epo lowe pe cei ed pain
in ensi y and exhibi g ea e pain ole ance. By educing emo ions such as ea , wo y, and ange associa ed wi h ch onic
pain, he expe ience o pain may appea less dis essing and o e whelming. Mo eo e , e ec i e use o coping s a egies,
such as unc ional ca e and e ocusing, enables indi iduals o egula e hei emo ional eac ions o pain. In his way,
beha io al emo ion egula ion can inc ease pain ole ance by educing he psychological dis ess associa ed wi h ch onic
pain (G eenway e al., 2021).
On he o he hand, Go ki e al. (2021) iden i ied li es yle choices as ano he ac o in luencing pain in ensi y. Li es yle
e e s o he ways indi iduals, amilies, and communi ies espond o hei physical, psychological, social, and economic
en i onmen s (Hen ich e al., 2021). I e lec s pa e ns shaped by sha ed alues and belie s wi hin a g oup o
communi y, mani es ed as common beha io s (Yildiz, 2021). Li es yle can also encompass bo h angible and in angible
de e minan s: angible ac o s ela e o demog aphic a iables such as indi idual cha ac e is ics, while in angible ac o s
pe ain o psychological aspec s like pe sonal alues, p e e ences, and a i udes (Wel en e al., 2018).
Li es yle has se e al de ining cha ac e is ics:
1. Exp essi eness – indi iduals and g oups exp ess hemsel es h ough pu pose ul beha io s.
2. Choice – indi iduals and g oups consciously choose beha io s o ep esen hemsel es. G ea e choice indica es a
b oade social s uc u e and educed ex e nal and in e nal cons ain s.
3. Dis inc ion – li es yle di e en ia es indi iduals wi h simila beha io s in ce ain con ex s om hose wi h di e gen
beha io s (Chou & Kim, 2021).
Li es yle can ha e a signi ican impac on pain in ensi y in indi iduals wi h ch onic pain. Unheal hy li es yles, such as
low physical ac i i y, poo die , and smoking, a e associa ed wi h highe pain in ensi y. This ela ionship ope a es
h ough se e al mechanisms. Fi s , inadequa e physical ac i i y and excess weigh exace ba e musculoskele al p oblems,
inc easing pain. Second, smoking and poo die a y habi s can in ensi y in lamma ion and o he ac o s ha wo sen pain
symp oms. Thi d, s ess a ising om poo die and unheal hy habi s may con ibu e o anxie y and dep ession, u he
ampli ying pe cei ed pain. E ec i e ch onic pain managemen equi es li es yle modi ica ions, including egula
physical ac i i y, balanced nu i ion, smoking cessa ion, and s ess managemen . A heal hy li es yle can educe
in lamma ion, anxie y, and dep ession while imp o ing o e all heal h, he eby alle ia ing pain in ensi y (Lahous e al.,
2022).
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In explaining he ela ionship be ween beha io al emo ion egula ion, li es yle, and pain in ensi y in pa ien s wi h ch onic
skele al pain diso de , i can be s a ed ha be e egula ion o emo ional eac ions and heal hie li es yles enable pa ien s
o educe hei pe cei ed pain in ensi y. App op ia e beha io al emo ion egula ion can alle ia e anxie y, dep ession, and
ange caused by ch onic pain, he eby educing pe cei ed pain. Simila ly, a heal hy li es yle can mi iga e in lamma ion,
s ess, and symp om exace ba ion, esul ing in educed pain. These wo ac o s may also in e ac ; o example, imp o ed
emo ion egula ion can lead o heal hie li es yle choices, u he educing pain in ensi y.
E ec i e ea men o ch onic skele al pain diso de mus conside hese ecip ocal e ec s and ocus on enhancing s ess
managemen , emo ion egula ion, heal hy li es yle habi s, and pain elie echniques o educe pain in ensi y. Howe e ,
ew s udies ha e examined he ole o ela ionship o hese a iables in educing pain in ensi y among indi iduals wi h
ch onic pain. Exis ing s udies, such as Lahous e al. (2022), ha e explo ed he ela ionship be ween li es yle and ch onic
cance pain, while Se isupa e al. (2021) in es iga ed he ole o cogni i e emo ion egula ion in pain managemen .
Ne e heless, based on he esea che ’s e iew, no p io s udy has simul aneously examined he ela ionship be ween
beha io al emo ion egula ion, li es yle, and pain in ensi y in pa ien s wi h ch onic skele al pain diso de .
The e o e, he p esen s udy aims o answe he ollowing ques ion: Is he e a ela ionship be ween beha io al emo ion
egula ion and li es yle wi h pain in ensi y in pa ien s wi h ch onic skele al pain diso de ?
Me hodology
The p esen esea ch is desc ip i e and co ela ional in na u e. Bo h ield-based (ques ionnai e) and lib a y-based (books
and a icles) da a collec ion me hods we e employed. This s udy is applied in e ms o pu pose, as i s esul s can be
u ilized o imp o e he s a us o he a iables. The s a is ical popula ion consis ed o all pa ien s wi h ch onic
musculoskele al pain diagnosed by physicians who isi ed pain clinics in Mashhad du ing he second qua e o 2023.
Due o he inabili y o coun he popula ion p ecisely, he sample size was es ima ed using he o mula p oposed by
Tabachnick and Fidell (2007). Acco ding o he p oposed o mula o co ela ional s udies, he minimum sample size was
calcula ed using he equa ion n > m + 50 (whe e 5 < p < 15). In his o mula, n ep esen s he sample size, p is a cons an
alue be ween 5 and 15, and m indica es he numbe o a iable componen s. Based on his ule, he sample size was
de e mined as ollows: (11 × 10) + 50 = 160, whe e 11 ep esen s he componen s o he a iables (5 o beha io al
emo ion egula ion, 5 o li es yle, and 1 o pain in ensi y), and he sample size was 160 indi iduals. Pa icipan s we e
selec ed using a con enience sampling me hod by app oaching pa ien s a pain clinics in Mashhad who me he inclusion
and exclusion c i e ia and we e willing o coope a e.
The equi ed da a we e collec ed using he Beha io al Emo ion Regula ion Ques ionnai e by K aaij and Ga ne ski
(2019), he Li es yle Ques ionnai e by Ke n e al. (1997), and he McGill Pain Ques ionnai e (2009).
Beha io al Emo ion Regula ion: The Beha io al Emo ion Regula ion Ques ionnai e was de eloped by K aaij and
Ga ne ski (2019) o measu e beha io al coping s a egies and o complemen he Cogni i e Emo ion Regula ion
Ques ionnai e, which ocused solely on cogni i e coping. The ques ionnai e includes i e dis inc concep ual subscales,
each consis ing o ou i ems. I is sco ed on a 5-poin Like scale (1 = almos ne e o 5 = almos always), wi h sco es
on each subscale anging om 4 o 20. The subscales include: (1) dis ac ion, (2) wi hd awal, (3) ac i e app oach, (4)
seeking social suppo , and (5) igno ing. The de elope s alida ed he scale using explo a o y ac o analysis, which
iden i ied i e ac o s wi h eigen alues g ea e han 1, explaining 78.6% o he o al a iance. The ac o loadings o he
i ems anged om 0.79 o 0.94. The psychome ic p ope ies o he ques ionnai e we e e alua ed in a s udy by K aaij and
Ga ne ski (2019) on a sample o 457 adul s om he gene al popula ion. C onbach's alpha eliabili y coe icien s o he
subscales we e epo ed as ollows: dis ac ion (0.86), ac i e app oach (0.91), seeking social suppo (0.91), igno ing
(0.89), and wi hd awal (0.93). Tes - e es eliabili y anged om 0.47 o 0.75, and concu en alidi y was epo ed as
0.67. In an I anian con ex , Sada Rasool and Alizadeh Fa d (2021) alida ed his ques ionnai e and epo ed a es - e es
eliabili y coe icien o 0.82 and C onbach’s alpha o 0.73, indica ing accep able eliabili y. Explo a o y ac o analysis
con i med he p esence o i e ac o s—dis ac ion, wi hd awal, ac i e app oach, seeking social suppo , and igno ing—
which oge he explained 66.84% o he o al a iance. In his s udy, C onbach’s alpha o his ques ionnai e was
calcula ed o be 0.86.
Li es yle: The Li es yle Ques ionnai e was de eloped by Ke n e al. (1997) o assess a ious dimensions o li es yle. This
ques ionnai e con ains 62 i ems di ided in o i e main subscales: (1) belonging-in e es , (2) coping, (3) esponsibili y, (4)
need o app o al, and (5) cau iousness. I ems a e sco ed on a 5-poin Like scale, wi h esponses anging om “s ongly
disag ee” (1) o “s ongly ag ee” (5). Fi een i ems a e e e se-sco ed, speci ically i ems 4, 12, 26, 30, 35, 40, 49, 52, 54,
55, 59, and 60. In a s udy conduc ed by Bashi i (2007), he C onbach’s alpha o his ques ionnai e was epo ed o
exceed 0.7, indica ing accep able eliabili y. In he p esen s udy, C onbach’s alpha o he Li es yle Ques ionnai e was
calcula ed a 0.90.
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Pain In ensi y: The Re ised McGill Pain Ques ionnai e (2009) was de eloped by Dwo kin e al. o expand and upda e he
o iginal McGill Pain Ques ionnai e by including bo h neu opa hic and non-neu opa hic pain indica o s. I consis s o 22
i ems a ed on a scale o 1 o 10, measu ing pain in ensi y. The indings demons a ed accep able eliabili y and alidi y
o his ques ionnai e. In I an, Tanhaei e al. (2012) examined he psychome ic p ope ies o he Re ised McGill Pain
Ques ionnai e. Fac o analysis esul s suppo ed he scale’s alidi y, and compa isons be ween pa ien s wi h and wi hou
pain p o ided e idence o c i e ion alidi y. Con en alidi y was also deemed su icien o measu ing pain in pa ien s.
Reliabili y was e alua ed using C onbach's alpha and spli -hal me hods, bo h o which demons a ed accep able
eliabili y. In his s udy, C onbach's alpha o he Re ised McGill Pain Ques ionnai e was calcula ed o be 0.79.
Findings
In his s udy, a o al o 160 pa ien s isi ing pain clinics in Mashhad pa icipa ed. Ou o hese 160 pa icipan s, 28.1%
we e unde 20 yea s old, 57.5% we e aged 20–30, 8.1% we e aged 31–40, 3.1% we e aged 41–50, and 3.1% we e o e
50 yea s old. Addi ionally, 85.6% we e single, and 14.4% we e ma ied. In e ms o educa ion, 0.6% had less han a high
school diploma, 29.4% had a high school diploma, 3.8% had an associa e deg ee, 49.4% held a bachelo 's deg ee, and
16.9% had a mas e 's deg ee o highe . Rega ding wo k expe ience, 90.6% had 0–5 yea s, 5.6% had 6–10 yea s, 1.3%
had 16–20 yea s, 1.3% had 21–25 yea s, and 1.3% had o e 25 yea s o wo k expe ience.
Table 1: Desc ip i e S a is ics o he Resea ch Va iables
Va iable Sou ce
N
Minimum
Maximum
Mean
S anda d De ia ion
Pain In ensi y
160
22
201
83.28
44.29
Dis ac ion
160
6
19
12.39
2.66
Wi hd awal
160
4
20
11.84
3.79
Emo ion Regula ion
Ac i e App oach
160
7
20
13.70
2.98
Seeking Social Suppo
160
4
20
13.69
3.82
Igno ing
160
4
20
10.41
3.92
Social In e es
160
16
33
24.80
3.53
Coping
160
24
41
32.54
3.55
Li es yle
Responsibili y
160
11
39
22.93
6.37
Need o App o al
160
17
35
26.51
3.68
Cau iousness
160
6
25
14.31
4.04
Based on he da a p esen ed in Table 1, he means and s anda d de ia ions o he s udy a iables a e shown sepa a ely.
To examine he ela ionship be ween emo ion egula ion, li es yle, and pain in ensi y in pa ien s wi h ch onic
musculoskele al pain a ending pain clinics in Mashhad, simul aneous linea eg ession analysis was employed. P io o
conduc ing he eg ession model, he assump ions o his s a is ical me hod we e assessed and con i med, including: 1.
he assump ion o uni a ia e no mali y, 2. he assump ion o no mul icollinea i y, 3. he assump ion o independence o
e o s, and 4. he assump ion o a ela ionship be ween he sco es o he dependen a iables.
Table 2: ANOVA and Reg ession Summa y Table o Pain In ensi y
C i e ion
Va iable
Sou ce o
Va ia ion
Sum o
Squa es
d
Mean
Squa es
F
Sig.
R
R²
Adjus ed
R²
Reg ession
35851.872
10
3585.187
Pain
In ensi y
Residual
276002.475
149
1852.366
1.93
0.045
0.33
0.11
0.05
To al
311854.344
159
-
Based on he da a p esen ed in Table 2, he signi icance le el o he F s a is ic o pain in ensi y, wi h deg ees o eedom
10 and 149, was calcula ed o be less han 0.01. This indica es ha he eg ession model is signi ican a he 0.05 le el (F
(10,149) = 1.93, p < 0.05). The a iables o emo ion egula ion and li es yle we e ound o e ec i ely p edic pain
in ensi y. Fu he mo e, he s eng h o he co ela ion, based on he alue o he mul iple co ela ion coe icien , was 0.11
o pain in ensi y, and he adjus ed R-squa ed alue was 0.05. This sugges s ha 5% o he a iance in he c i e ion
a iable, pain in ensi y, can be explained by he p edic o s, namely emo ion egula ion and li es yle.
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Table 3: Pea son Co ela ion o Emo ional Regula ion and Pain In ensi y
Va iable
Dis ac ion
Wi hd awal
Ac i e
App oach
Seeking Social
Suppo
Igno ing
indica o
Pain
In ensi y
R
0.116
0.168*
0.066
-0.023
0.159*
Sig.
0.142
0.033
0.407
0.772
0.045
**Signi ican a 0.05; N = 160
Acco ding o he esul s o he co ela ion es , he e is a signi ican posi i e ela ionship a he 0.95 con idence le el
be ween wi hd awal and pain in ensi y wi h a co ela ion coe icien o = 0.168, as well as be ween igno ing and pain
in ensi y wi h a co ela ion coe icien o = 0.159.
Table 4: Pea son Co ela ion o Li es yle and Pain In ensi y
Va iable
Social
In e es
Coping
Responsibili y
Need o
App o al
Cau iousness
indica o
Pain
In ensi y
R
-0.081
-0.190*
0.036
-0.077
0.202*
Sig.
0.308
0.016
0.653
0.333
0.010
**Signi ican a 0.05; N = 160
Acco ding o he esul s o he co ela ion es , he e is a signi ican nega i e ela ionship a he 0.95 con idence le el
be ween coping and pain in ensi y, wi h a co ela ion coe icien o = -0.190. Addi ionally, he e is a signi ican posi i e
ela ionship a he 0.95 con idence le el be ween being cau ious and pain in ensi y, wi h a co ela ion coe icien o =
0.202.
Discussion o Findings
Based on he esul s o he co ela ion es , he e is a signi ican posi i e ela ionship be ween wi hd awal ( = 0.168) and
igno ing ( = 0.159) wi h pain in ensi y. This inding aligns wi h he esul s o s udies conduc ed by Saidi e al. (2022),
Jahangi i e al. (2022), Ansa i and Aghababaei (2020), A ya and e al. (2019), S isupa e al. (2021), and Russell and Pa k
(2018).
Saidi e al. (2022) demons a ed ha ch onic pain componen s can be p edic ed based on emo ional egula ion s a egies
in pa ien s wi h ch onic pain. Jahangi i e al. (2022) showed ha a achmen s yles and ego s eng h, media ed by
cogni i e emo ion egula ion, indi ec ly a ec pain adap a ion. Simila ly, Ansa i and Aghababaei (2020) ound ha
emo ion egula ion s a egies p edic pain pe cep ion among homemake s. A ya and e al. (2019) con i med he
media ing ole o emo ion egula ion ( eapp aisal and supp ession) in he ela ionship be ween in e nal locus o con ol
and pain in ensi y. Fu he mo e, S isupa e al. (2021) e ealed a signi ican ela ionship be ween he use o emo ion
egula ion skills and pain managemen , while Russell and Pa k (2018) demons a ed a posi i e ela ionship be ween
emo ion egula ion and sel -managemen o pain.
In he p esen s udy, a signi ican posi i e co ela ion was obse ed be ween wi hd awal, as a beha io al emo ion
egula ion s a egy, and pain in ensi y in pa ien s wi h ch onic skele al pain. Wi hd awal is conside ed a maladap i e
s a egy o managing s ess ul e en s. Acco ding o Go man and S an on (2021), his s a egy in ol es a emp ing o
di e a en ion om s ess ul si ua ions h ough engagemen in al e na i e ac i i ies. Al hough wi hd awal may p o ide
empo a y elie , i can ul ima ely inc ease an indi idual's ocus on pain, leading o heigh ened pain pe cep ion. This
s a egy, o en used as a means o escape o a oid s esso s, can c ea e a maladap i e cycle in pa ien s wi h ch onic
skele al pain. A oidance o ac i i ies ha may exace ba e pain educes oppo uni ies o de elop heal hie coping
mechanisms o managing pain and s ess. O e ime, his app oach no only inc eases pain in ensi y bu also nega i ely
impac s quali y o li e, le els o physical ac i i y, and social in e ac ions.
The indings also e ealed a signi ican posi i e co ela ion be ween igno ing, ano he beha io al emo ion egula ion
s a egy, and pain in ensi y. Igno ing s ess ul si ua ions in ol es empo a ily shi ing ocus o o he ac i i ies o a oid
p essu e, gi ing he mind a sho - e m ep ie e. Go man and S an on (2021) explain ha igno ing en ails beha ing as
hough he s ess ul si ua ion does no exis . Al hough his s a egy may appea o empo a ily alle ia e s ess, i can
exace ba e pain in he long un because i p e en s indi iduals om lea ning and implemen ing mo e e ec i e coping
mechanisms.
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Igno ing can be iewed as a o m o cogni i e a oidance, whe e indi iduals e ade p ocessing dis essing hough s,
emo ions, o in o ma ion. While cogni i e a oidance may educe immedia e emo ional dis ess, i can ul ima ely inc ease
pain sensi i i y h ough diminished coping skills and awa eness. Neu ophysiological mechanisms associa ed wi h
emo ion egula ion and pain pe cep ion may u he in ensi y his e ec . By a oiding s esso s and nega i e emo ions,
indi iduals may inad e en ly heigh en hei sensi i i y o pain, which inc eases pain in ensi y in pa ien s wi h ch onic
skele al condi ions.
Addi ionally, he esul s demons a ed a signi ican nega i e co ela ion be ween coping ( = -0.190) and pain in ensi y
and a signi ican posi i e co ela ion be ween cau iousness ( = 0.202) and pain in ensi y. These indings a e consis en
wi h s udies conduc ed by Ja a i and Shi Alizadeh (2023), Mohammadi e al. (2021), Asadi Aila e al. (2014), Rahimian
Booga and Ros ami (2012), Lahos e al. (2022), and Go chi e al. (2021).
Ja a i and Shi Alizadeh (2023) highligh ed he media ing ole o li es yle in p edic ing pain in ensi y based on emo ional
exp essi eness in women wi h b eas cance . Mohammadi e al. (2021) demons a ed a s ong posi i e ela ionship
be ween a heal h-p omo ing li es yle and pain accep ance. Asadi Aila e al. (2014) ound ha an Islamic li es yle
nega i ely p edic s pain in cance pa ien s. Simila ly, Rahimian Booga and Ros ami (2012) e ealed ha li es yle
signi ican ly p edic s mig aine headaches. Lahos e al. (2022) demons a ed a signi ican ela ionship be ween adop ing a
heal hy li es yle and educed pain, while Go chi e al. (2021) epo ed ha an unheal hy li es yle is di ec ly associa ed
wi h he p og ession o ch onic pain.
In he cu en s udy, a signi ican nega i e ela ionship be ween coping as a li es yle componen and pain in ensi y was
obse ed in pa ien s wi h ch onic skele al pain. This ela ionship indica es he c i ical ole o psychological p ocesses in
in luencing he physiological expe ience o pain, e ec i ely ac ing as a b idge be ween mind and body. Indi iduals wi h
g ea e coping skills a e be e equipped o manage li e s esso s, esul ing in educed pain in ensi y. These indings
highligh he impo ance o adop ing posi i e and ac i e app oaches o li e’s challenges, e en in indi iduals su e ing
om ch onic pain.
Coping s a egies as pa o a li es yle encompass me hods such as p oblem-sol ing, seeking social suppo , posi i e
hinking, and mind ulness. E ec i e s ess managemen no only alle ia es pain expe iences bu also imp o es quali y o
li e and o e all well-being. Indi iduals who u ilize ac i e coping s a egies and pe cei e a sense o con ol o e hei
li es a e mo e likely o expe ience lowe pain in ensi y. This sense o con ol empowe s indi iduals o manage s esso s
and pain ul si ua ions e ec i ely.
Finally, he esul s showed a signi ican posi i e co ela ion be ween cau iousness as a li es yle componen and pain
in ensi y. This ela ionship sugges s ha indi iduals who exhibi excessi e cau iousness may expe ience highe le els o
pain. O e ly cau ious indi iduals o en ocus excessi ely on po en ial isks and conce ns, which can lead o ch onic
s ess and anxie y— wo ac o s known o heigh en pain pe cep ion.
Ch onic s ess and anxie y keep he body in a pe sis en s a e o physiological a ousal, inc easing pain sensi i i y.
Addi ionally, cau ious indi iduals may a oid physical o social ac i i ies ha a e bene icial o alle ia ing pain. Physical
ac i i y educes pain in ensi y by enhancing ci cula ion and s eng hening muscles, which alle ia es p essu e on he
musculoskele al sys em. By a oiding such ac i i ies, o e ly cau ious indi iduals miss ou on hese bene i s.
Mo eo e , excessi e cau iousness can in ensi y physiological s ess esponses, such as he o e p oduc ion o co isol, a
s ess ho mone ha inc eases pain sensi i i y and p omo es in lamma ion. Ele a ed co isol le els may, he e o e,
con ibu e o heigh ened pain pe cep ion in pa ien s wi h ch onic skele al condi ions.
Conclusion
The indings o he cu en s udy unde sco e he signi ican oles o emo ion egula ion s a egies and li es yle
componen s in pain in ensi y among indi iduals wi h ch onic skele al pain. Maladap i e s a egies such as wi hd awal,
igno ing, and excessi e cau iousness a e posi i ely associa ed wi h pain in ensi y, while adap i e s a egies like coping
play a p o ec i e ole in educing pain. These esul s emphasize he impo ance o in e en ions ha p omo e ac i e
coping mechanisms, educe cogni i e a oidance, and encou age balanced and heal h-p omo ing li es yles o imp o e
pain managemen ou comes.
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