The Association of Perceived Controllability, Fear, and Catastrophizing With Pain Experience: Insights From a Cross-sectional Study in Individuals With Lateral Elbow Tendinopathy

OBJECTIVE: To investigate associations between locus of control, fear, and pain experience in individuals with lateral elbow tendinopathy (LET). DESIGN: Cross-sectional observational study using validated patient-reported outcome measures alongside neurophysiological assessments. METHODS: Participants with LET were assessed using the Short-Form McGill Pain Questionnaire, numeric pain-rating scale, and Central Sensitization Inventory to evaluate pain intensity. Pain interference was measured via the Patient-Specific Functional Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Fear-Avoidance Beliefs Questionnaire. Neurophysiological aspects of pain were evaluated using Pain-Free Grip Strength, Two-Point Discrimination, and Laterality tests. Group characteristics were compared using chi-square and independent-samples t tests. Logistic regression identified significant predictors of chance locus of control, and linear regression analyzed the association of pain intensity with fear-avoidance behaviors. RESULTS: There was a significant association between higher levels of fear-avoidance beliefs, increased pain catastrophizing, and elevated continuous pain intensity. Psychological factors were associated with pain experience in LET. Chance locus of control was not associated with LET pain. CONCLUSION: Psychological constructs, particularly fear-avoidance beliefs and catastrophizing, were strongly associated with pain intensity in LET. These results underscore the importance of addressing psychological factors in clinical management to improve patient outcomes. JOSPT Open 2026;4(1):111-120. Epub 9 December 2025. doi:10.2519/josptopen.2025.0179