Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population

Abstract

Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain. The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL). The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention.

The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain

“…Results of the partial correlation analyses demonstrate that the relationship between performance on the forward bend task and disability is driven by the tendency of people with high fear to restrict motion of the lumbar spine. Our findings indicate that initial levels of pain-related fear are significantly correlated with disability up to 3 months following the onset of low back pain, which is consistent with the existing evidence that fear avoidance behavior is a potent predictor of future disability and risk for chronic pain [4,6,7,10,11,13,41].…”

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

“…These results suggest that the correlation previously found between catastrophizing, LBP and LBP-related disability in cross-sectional studies, [13][14][15][16][17][18] may be of little practical clinical value, since it might be explained by the fact that the OR for improvement in catastrophizing increases with pain improvement (Table 5). Results from a study conducted in the same cultural setting, showed that the correlation of catastrophizing and other psychological variables with disability, ceases to be significant when variations of trait anxiety are taken into account, suggesting that other psychological variables may play a more relevant role than catastrophizing.…”

“…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.…”

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…2,3,34 For example, fear can rivet attention on the most frightening aspects of a situation (worsening "focalism") or convince a person that a possible threat is inevitable. 53,62 Distress can block memories of better times, limiting one's ability to form more hopeful beliefs about the future. 63,64 Patients who are afraid and upset project these intense feelings onto the future, 65 and anxiety can undermine the reflectiveness needed to recognize such projections and address them.…”