The impact of social support on pain intensity in older adults with chronic pain: the serial mediating roles of positive and negative affect and pain catastrophizing

Background Chronic pain in older adults represents a major public health concern, with non-pharmacological interventions gaining importance as a key strategy for pain management. Social support, positive and negative affect, and pain catastrophizing are known to be associated with pain intensity in older adults. This study aimed to investigate the effect of social support on pain intensity in older adults with chronic pain and to explore the mediating roles of positive affect, negative affect, and pain catastrophizing. Methods This cross-sectional study involved 363 older adults with chronic pain who completed the Social Support Rating Scale (SSRS), Positive and Negative Affect Scale (PANAS), Pain Catastrophizing Scale (PCS), and Numeric Rating Scale (NRS). Serial mediation analysis was conducted to test whether positive and negative affect and pain catastrophizing act sequentially as mediators between social support and pain intensity. Structural equation modeling (SEM) was conducted using Mplus 8.3 to examine whether positive and negative affect and pain catastrophizing serially mediate the association between social support and pain intensity. Results Social support was negatively associated with pain intensity, both directly and indirectly, through the separate mediating effects of positive affect (β = -0.129, 95% CI: -0.176, -0.082) and pain catastrophizing (β = -0.199, 95% CI: -0.262, -0.136). The sum of these indirect effects accounted for 49.84% of the total effect. Furthermore, social support was indirectly associated with reduced pain intensity via the serial mediation of negative affect and pain catastrophizing (β = -0.088, 95% CI: -0.131, -0.059) and the serial mediation of positive affect and pain catastrophizing (β = -0.066, 95% CI: -0.099, -0.043). These pathways collectively accounted for 23.40% of the total effect. Conclusion Healthcare providers (e.g., nurses, physicians, and therapists) should enhance chronic pain management by assessing patients’ social support levels and implementing interventions focused on emotional regulation and cognitive restructuring. An interdisciplinary approach is recommended to effectively reduce pain intensity in older adults. Trial registration Not applicable.