The Relation Between Pain-Related Fear and Disability: A Meta-Analysis

Abstract

Within a biopsychosocial framework, psychological factors are thought to play an important role in the onset and progression of chronic pain. The cognitive-behavioral fear-avoidance model of chronic pain suggests that pain-related fear contributes to the development and maintenance of pain-related disability. However, investigations of the relation between pain-related fear and disability have demonstrated considerable between-study variation. The main goal of the current meta-analysis was to synthesize findings of studies investigating cross-sectional associations between pain-related fear and disability, in order to estimate the magnitude of this relation. We also tested potential moderators, including type of measure used, demographic characteristics, and relevant pain characteristics. Searches in PubMed and PsycINFO yielded a total of 46 independent samples (N = 9579) that reported correlations between pain-related fear and disability among persons experiencing acute or chronic pain. Effect size estimates were generated using a random effects model and artifact distribution method. The positive relation between pain-related fear and disability was observed to be moderate to large in magnitude, and stable across demographic and pain characteristics. Although some variability was observed across pain-related fear measures, results were largely consistent with the fear-avoidance model of chronic pain.

Pain in older people with frailty

“…Avoidance and withdrawal behaviours, common in both pain and depressed populations 41 could be relevant. The fear avoidance model of pain proposes that when a person perceives pain as threatening they typically respond with pain related fear avoidance behaviour 42 which results in decreased functioning and disability 43 . A recent meta-analysis identified a strong association between pain related fear and disability 42 but because only cross-sectional studies were included, inferences about the direction of the relationship were precluded.…”

“…A recent meta-analysis identified a strong association between pain related fear and disability 42 but because only cross-sectional studies were included, inferences about the direction of the relationship were precluded. However, as frailty is often combined with disability and comorbidity 42 , and the overlap increases with greater frailty 44 , there is an obvious substrate for a perpetuating cycle of pain, depression and immobility, thus compromising the life of the older person.…”

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review

“…1,9,11,[13][14][15][16][17][18][19][20] Chronic pain can significantly interfere with participation in daily living activities, both as a result of limited mobility resulting from the source of pain and fear-driven avoidance of specific activities. 8,15,16,[21][22][23][24] Childhood chronic pain has been associated with disturbances in sleep, increased fatigue, depression, and decreased physical functioning. 11 Unmanaged pain leads to social, functional, and behavioral consequences, increased stress on the family, and unnecessary prolonged suffering by the child.…”

Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes

“…Fear-avoidance [123,124], is included in paper 3 and paper 4, and fear-avoidance has also gained extensive attention also in previous research on chronic pain [121,125,126]. The fear-avoidance model is an established model for explaining behavioural consequences of pain.…”

“…In addition, catastrophizing is a suggested part of the fear-avoidance model [121][122][123], which is developed with an attempt to theoretically explain the wide variation in individual responses to pain [124]. The two factors fear and avoidance are at the core of the model, possibly preceded by catastrophizing as a result of a pain experience.…”