The influence of pain and pain-related fear and disability beliefs on walking velocity in chronic low back pain

Abstract

The purpose of this study was to examine the influence of anticipation of pain, sensory perception of pain and pain-related fear and disability beliefs on the gait characteristics of patients with chronic low back pain (CLBP). Thirty-one individuals with CLBP (16 men and 15 women) and 24 healthy individuals (11 men and 13 women) between 20 to 56 years of age participated in this study. Anticipated pain and the pain actually felt were measured with two separate visual analogue scales before and after preferred and fast walking performances. Pain-related fear and disability beliefs were measured with the Fear-Avoidance Belief Questionnaire (FABQ) and the Disability Belief Questionnaire (DBQ). Spatial and temporal walking parameters were measured at preferred and fast walking performances using a computerized gait mat. Analysis of variance demonstrated significant differences between patients and healthy individuals in step length, single support time and walking velocity (P<0.05). Within the CLBP group, stepwise regression analysis showed that FABQ (physical activity) and anticipated pain were the strongest predictors of velocity deficits in preferred and fast walking respectively. Anticipation and fear of pain accounted significantly for the velocity deficits in walking. Standard clinical gait assessments must incorporate psychological measures of pain experience.

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

“…Consistent with this model, acute and chronic low back pain patients with high pain-related fear typically show submaximal performance on a variety of physical challenges such as straight leg raise, knee-extension-flexion, trunkextension-flexion, and weight lifting [1,2,5,7,11,12,16,30,34,38,41]. These findings suggest that performance during forward bend tasks, as measured by thoracic, lumbar and hip excursions, may be influenced by individual differences in pain-related fear.…”

“…1 The effects of group and day on the peak to peak joint excursions of the lumbar spine are depicted PASS, TSK, and PCS), suggesting a robust and potentially important clinical finding. Although pain-related fear has previously been related to submaximal performance on a variety of physical challenges [1,2,5,7,11,12,16,30,34,35,38,41] a unique feature of this study is a mapping of this construct to joint movements during performance of a routine assessment procedure for patients with low back pain. Specifically, at each testing session participants with high levels of fear displayed less lumbar flexion during forward bending, even after statistically controlling for pain.…”

Influence of pain and depression on fear of falling, mobility, and balance in older male veterans

“…Pain-related fear of movement is often manifested in patients who experience chronic low-back pain that limits their daily activities [46]. Furthermore, pain-related fear or anticipated pain is a better predictor of walking velocity than actual pain in those with chronic back pain [47]. Although we did not specifically assess fear of pain in this study, we speculate that this personal factor may also be present in older adults with pain and increased fear of falling.…”

Identifying Patient Fear-Avoidance Beliefs by Physical Therapists Managing Patients With Low Back Pain

“…Additionally, physical therapists may believe that identifying fear-avoidance beliefs during the clinical exam is intuitive, as several factors observed during the clinical exam have been found to correlate with fear-avoidance scores. 2,3,12,13,20,23,48,55,58 Experienced physical therapists may feel that they are able to discern which patients have elevated fear-avoidance beliefs without administering validated self-report questionnaires.…”