Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.

Pain Catastrophizing Is Associated With Health Indices in Musculoskeletal Pain: A Cross-Sectional Study in the Dutch Community.

“…Also, some prospective studies suggest that fear-avoidance beliefs and pain catastrophizing are precursors of pain-related disability rather than consequences (Burton, Tillotson, Main, & Hollis, 1995;Klenerman et al, 1995;Linton, Buer, Vlaeyen, & Hellsing, 2000;Linton & Hallden, 1998). Overall, the results of these studies are consistent with the fear-avoidance model developed by Vlaeyen, Kole Snijders, Boeren, and van Eek (1995), which suggests that pain catastrophizing and fear of movement or (re)injury foster the development of chronic pain problems.…”

The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients: a study in routine clinical practice within the Spanish National Health Service

“…32 Results from randomized controlled trials and small prospective studies are inconsistent. 2,4,7,12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] Differences in sample size, recruitment context (e.g., patients treated in routine practice vs. secondary analyses of data gathered in clinical trials), patients' characteristics, and statistical methods used across studies (e.g., use of hierarchical vs. non-hierarchical models) can account for this inconsistency. For instance, the use of hierarchical models implies pre-hoc assumptions and favors those variables which the authors choose to enter first, since these have a greater chance of attaining statistical significance.…”

“…[1][2][3][4][5][6][7][8][9] FAB refer to the fear-induced avoidance of movements or activities which are expected to be painful, whereas catastrophizing is defined as an exaggerated negative mental state related to an actual or anticipated painful experience. [1][2][3][4][5][6][7][8][9] In the Spanish cultural environment, FAB have shown to have an either negligible or nonexistent influence on LBP among elderly populations and among acute, subacute and chronic LBP patients treated in routine practice, [10][11][12][13] whereas catastrophizing correlates with disability and explains approximately one fourth of its variance, 13,14 suggesting that it may have an influence on the prognosis of LBP patients.…”

“…This poses a "chicken and egg" dilemma, on the potential reciprocal influence between catastrophizing and lack of clinical improvement. 3,[7][8][9] In fact, previous cross-sectional studies have shown that catastrophizing, pain and disability correlate with each other, [13][14][15][16][17][18] but results from prospective studies are inconsistent. Some randomized controlled trials and small studies in routine practice suggest that baseline catastrophizing is associated with the evolution of pain and disability, some suggest the contrary, and others conclude that catastrophizing predicts the outcome of acute LBP, but not before 6 weeks after the onset of pain.…”

“…Some randomized controlled trials and small studies in routine practice suggest that baseline catastrophizing is associated with the evolution of pain and disability, some suggest the contrary, and others conclude that catastrophizing predicts the outcome of acute LBP, but not before 6 weeks after the onset of pain. 2,4,7,[19][20][21][22][23][24][25][26][27][28][29][30][31] Results from the only large prospective study conducted in routine practice, suggest that baseline catastrophizing does not predict the evolution of LBP-related disability. 32 If catastrophizing were to actually have a negative influence on prognosis, it would follow that, in routine practice, clinicians should identify patients in whom psychological treatment to address catastrophizing should be considered.…”