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Panhale, Vrushali P., Prachita P. Walankar, and Sayali S. Khedekar. "Chronic Pain and Fear-Avoidance Beliefs: A Narrative Review." International Journal of Health Sciences and Research 11, no. 6 (June 22, 2021): 219–25. http://dx.doi.org/10.52403/ijhsr.20210634.
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Chronic pain has an impact not only on the physical function but also affects the quality of life of an individual. Psychosocial factors play an important role in mediating chronic pain. Fear-avoidance belief is considered as the important psychosocial factor in predicting patient's avoidance for work and physical activity as well as disability and has strong association with chronic pain. The aim of the study is to review the studies on the relationship between chronic pain and fear-avoidance beliefs. Articles from the PubMed, Research gate, Google Scholar and APTA databases were searched for this narrative review with related keywords like chronic pain, chronic musculoskeletal pain, fear avoidance beliefs, psychosocial factors and quality of life. Total fifteen articles were found. Out of which, five were excluded and ten were studied further. The sum of evidences proves that the fear-avoidance belief is an important predictor of pain. Through this we conclude that the anticipation of chronic pain can further provoke fear-avoidance behaviour and can give rise to a vicious cycle, in which fear can contribute to avoidance of physical activity and work leading to disability. Key words: chronic, pain, fear avoidance beliefs.
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Wilson, Anna C., Amy S. Lewandowski, and Tonya M. Palermo. "Fear-Avoidance Beliefs and Parental Responses to Pain in Adolescents with Chronic Pain." Pain Research and Management 16, no. 3 (2011): 178–82. http://dx.doi.org/10.1155/2011/296298.
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BACKGROUND: The fear-avoidance model of chronic pain posits that fear of pain is associated with fear and avoidance of activity, which can lead to deconditioning and persistence of pain and disability. Despite being well supported in adults, little is known about the role of fear-avoidance beliefs regarding physical activity in children. Research has shown that parental protectiveness contributes to activity limitations in children; however, no studies have examined relationships between protectiveness, and fear and avoidance.OBJECTIVES: To conduct a cross-sectional study to provide additional information regarding the reliability and validity of the Fear-Avoidance Beliefs Questionnaire physical activity subscale among adolescents with chronic pain; examine fear-avoidance beliefs and depressive symptoms as concurrent predictors of physical activity limitations; and test competing models using fear-avoidance beliefs as mediators and moderators of the association between parental protectiveness and activity limitations.METHODS: Adolescents (n=42) 11 to 17 years of age with chronic pain completed questionnaires assessing pain intensity, fear-avoidance beliefs, depressive symptoms and physical activity limitations. Their parents completed questionnaires regarding protectiveness and adolescent activity limitations.RESULTS: The Fear-Avoidance Beliefs Questionnaire physical activity subscale was useful for assessing fear-avoidance beliefs in the present population. In support of hypotheses, greater fear-avoidance beliefs were associated with greater activity limitations, above pain intensity and depressive symptoms. Support was found for fear-avoidance beliefs as mediators of the association between parental protectiveness and activity limitations. Tests of moderation were not significant.CONCLUSIONS: Fear-avoidance beliefs may be an important target for interventions focused on decreasing activity limitations in youth with chronic pain. Future research should investigate these associations longitudinally.
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Gatchel, Robert J., Randy Neblett, Nancy Kishino, and Christopher T. Ray. "Fear-Avoidance Beliefs and Chronic Pain." Journal of Orthopaedic & Sports Physical Therapy 46, no. 2 (February 2016): 38–43. http://dx.doi.org/10.2519/jospt.2016.0601.
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George, Steven Z., Joel E. Bialosky, and Julie M. Fritz. "Physical Therapist Management of a Patient With Acute Low Back Pain and Elevated Fear-Avoidance Beliefs." Physical Therapy 84, no. 6 (June 1, 2004): 538–49. http://dx.doi.org/10.1093/ptj/84.6.538.
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Abstract Background and Purpose. Elevated fear-avoidance beliefs are believed to be a precursor of chronic disability, yet effective intervention options have not been described in the literature. The purpose of this case report is to describe physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. Case Description. The patient was a 42-year-old sales manager with acute low back pain. The patient had no previous history of activity-limiting low back pain and initially had limitations in straight leg raising, limitations in lumbar movement, and elevated fear-avoidance beliefs. Intervention. Treatment-based classification and graded exercise were used. Outcome. Disability, fear-avoidance beliefs, and pain decreased 4 weeks after starting physical therapy. Six months later, disability and fear-avoidance beliefs had increased, but were still improved when compared with the initial measurements. Discussion. Disability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.
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Kromer, Thilo O., Judith M. Sieben, Rob A. de Bie, and Caroline H. G. Bastiaenen. "Influence of Fear-Avoidance Beliefs on Disability in Patients With Subacromial Shoulder Pain in Primary Care: A Secondary Analysis." Physical Therapy 94, no. 12 (December 1, 2014): 1775–84. http://dx.doi.org/10.2522/ptj.20130587.
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Background Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome. Objective The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up. Design A cross-sectional and longitudinal analysis was conducted. Methods Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses. Results Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months. Limitations Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group. Conclusions Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.
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Macías-Toronjo, Israel, María Jesús Rojas-Ocaña, José Luis Sánchez-Ramos, and E. Begoña García-Navarro. "Pain catastrophizing, kinesiophobia and fear-avoidance in non-specific work-related low-back pain as predictors of sickness absence." PLOS ONE 15, no. 12 (December 10, 2020): e0242994. http://dx.doi.org/10.1371/journal.pone.0242994.
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The influence of pain catastrophizing, kinesiophobia and fear-avoidance attitudes towards non-specific low-back pain has been scarcely studied in an occupational insurance provider context. The objective of this work is to ascertain the relationship between these psychosocial variables with work absence, its duration and the disability of subjects with work-related low back pain. This is a descriptive observational methodological strategy. All patients with work-related non-specific low back pain who attended to an occupational health hospital during the study period were included consecutively. Clinical variables of kinesiophobia, pain catastrophizing, fear-avoidance attitudes, disability and pain were collected; sociodemographic variables of sex, age, type of work, educational level, occupational status and duration in days of work absence were recorded. Kinesiophobia (b = 1.43, P = 0.011, r = 0.333), fear-avoidance beliefs in its global dimension (b = 0.910, P = 0.014, r = 0.321), fear-avoidance beliefs in its work dimension (b = 1.255, P = 0.016, r = 0.321) and pain catastrophizing (b = 0.997, P = 0.013, r = 0.340) show individual association with the duration of sickness absence. Kinesiophobia (b = 0.821, P = 0.011, r = 0.30) and fear-avoidance beliefs (b = 1.760, P = 0.016, r = 0.28) are associated with disability (Kinesiophobia, b = 0.880, P = 0.045, r = 0.26; Fear-avoidance beliefs, b = 0.724, P = 0.010, r = 0.34). Kinesiophobia, fear-avoidance beliefs and pain catastrophizing are related to an increase in the duration of work absence and disability in patients with back pain in an occupational insurance provider context.
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Kroska, Emily B. "A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain." Scandinavian Journal of Pain 13, no. 1 (October 1, 2016): 43–58. http://dx.doi.org/10.1016/j.sjpain.2016.06.011.
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AbstractBackgroundThe fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples.MethodThe present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede’s cultural dimensions). Publication bias was examined using the funnel plot and the p-curve.ResultsResults indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed for studies that utilized measures of experiential avoidance when compared to studies that utilized pain-specific fear-avoidance measures. Studies that utilized multiple measures of fear-avoidance had stronger effect sizes than studies that utilized a single measure of fear-avoidance. Three of Hofstede’s cultural dimensions moderated the association, including Power Distance Index, Individualism versus Collectivism, and Indulgence versus Restraint.ConclusionsThe present meta-analysis synthesizes the results from studies examining the association between fear-avoidance and pain intensity among individuals with chronic pain. The positive association indicates that those with increased fear-avoidance have higher pain intensity, and those with higher pain intensity have increased fear-avoidance. Findings indicate that cultural differences and measurement instruments are important to consider in understanding the variables that affect this association. The significant cultural variations may indicate that it is important to consider the function of avoidance behavior in different cultures in an effort to better understand each patient’s cultural beliefs, as well as how these beliefs are related to pain and associated coping strategies.ImplicationsThe results from the current meta-analysis can be used to inform interventions for patients with chronic pain. In particular, those with more intense pain or increased fear-avoidance should be targeted for prevention and intervention work. Within the intervention itself, avoidance should be undermined and established as an ineffective strategy to manage pain in an effort to prevent disability, depression, and physical deconditioning.
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Sharath, Sherene E., Panos Kougias, and Neal R. Barshes. "The influence of pain-related beliefs on physical activity and health attitudes in patients with claudication: A pilot study." Vascular Medicine 22, no. 5 (May 25, 2017): 378–84. http://dx.doi.org/10.1177/1358863x17709944.
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We examined how pain beliefs are related to symptom severity, expectations of risk/benefits, and baseline physical activity among claudicants. Eligible patients at the Michael E DeBakey Veterans Affairs Medical Center were administered questionnaires that measured: fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire [FABQ]), walking impairment, baseline physical activity, claudication type, and risk/benefit attitudes. Among 20 participants, the median age was 69 years (IQR: 66–75). In our efforts to understand how fear-avoidance beliefs influenced physical activity among people with claudication, we found that 12 out of 19 participants (63%) thought that the primary etiology of their pain was walking, while 18 (out of 20) (90%) people thought that walking would exacerbate their leg symptoms – suggesting that there was some confusion regarding the effects of walking on claudication. Those who expected that walking would benefit their symptoms more than surgery reported fewer fear-avoidance beliefs ( p=0.01), but those who believed that walking would make their leg pain worse expected greater benefit from surgery ( p=0.02). As symptom severity increased, fear-avoidance beliefs also increased ( p=0.001). The association between symptom severity and fear-avoidance beliefs indicates that as pain or impairment increases, the likelihood of avoiding behaviors that are thought to cause pain might also increase. Accounting for pain-related beliefs when recommending physical activity for claudication should be considered.
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Zdun-Ryżewska, Agata, and Krzysztof Basiński. "Fear avoidance model – review of selected reports." BÓL 17, no. 4 (January 6, 2017): 41–48. http://dx.doi.org/10.5604/01.3001.0009.7382.
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SUMMARY: Based on the bio-psycho-social approach, fear-avoidance model can be used in situations when somebody avoids movement because of fear of pain. This model can be applied in groups of patients with low back pain and musculoskeletal pain and explains how acute pain becomes chronic. A simple behavioral model of classical and operant conditioning that explains activity avoidance was developed into a more sophisticated, cognitive-behavioral fear-avoidance model, postulating the existence of a vicious circle that causes increasing disability of patients in chronic pain. The variables involved in this mechanism are catastrophizing, fear of activity, avoiding movement, increased distress and fear-avoidance beliefs. This article also presents some further improvements to the model that include pain intensity and motivational theory. A brief overview of tools used in research on fear-avoidance is also presented. It is recommended to take Fear Avoidance Model in to consideration when working with patients with no improvement and the risk of recurrent episodes of pain. Further studies are needed to empirically verify the fear-avoidance model.
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Thomtén, Johanna, and Andreas Karlsson. "Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden." Scandinavian Journal of Pain 5, no. 3 (July 1, 2014): 193–99. http://dx.doi.org/10.1016/j.sjpain.2014.01.003.
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AbstractObjectivesOne in five women under the age of 30 report recurrent genital pain and pain during sexual intercourse. Female genital pain negatively affects sexual and general health, as well as dyadic function and quality of life. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, there is still a lack of theoretical models describing the psychosocial mechanisms involved in the development of genital pain. Originally developed to outline the transition from acute to chronic back pain, the fear avoidance (FA) model has lately been proposed as a possible tool in illustrating the mechanisms involved in genital pain. However, only few studies have empirically tested the components of the FA model empirically. The aim of the present study is to examine fear avoidance beliefs, pain catastrophizing, and symptoms of depression and anxiety among women reporting genital pain, and to relate these concepts to sexual satisfaction/function and the characteristics of pain.MethodsThe study was a population-based study using a postal questionnaire administered to 4052 women (age 18–35). Of these 944 (response rate: 23%) took part in the study.ResultsGenital pain of six months duration was reported by 16.1% of the women. Women with pain reported elevated levels of symptoms of anxiety, fear avoidance beliefs, pain catastrophizing and anxiety sensitivity. Symptoms of anxiety also predicted pain in the explanatory model together with vaginal tension and fungal infection. Vaginal tension has previously been described as a fear-response to painful intercourse and the results thereby seem to give further support to viewing genital pain from a fear avoidance perspective. Furthermore, fear avoidance beliefs seem to be of similar importance as lack of desire for the experience of sexual satisfaction and could also predict pain during specific activities among women with pain. The results also indicate that sexual satisfaction is related to a specific pain-related fear, rather than a heightened level of general anxiety.ConclusionsThe study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing.ImplicationsIt seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual function and satisfaction and increased pain experience. It is possible that psychological mechanisms work in the transition from acute physiological pain to chronic psychologically maintained pain in terms of secondary reactions to, e.g. repeated fungal infections by adding emotional distress, fear of pain and avoidance behaviours.
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Tribian, Annika, Jonas Vinstrup, Emil Sundstrup, Kenneth Jay, Klaus Bös, and Lars L. Andersen. "Physical activity during work and leisure show contrasting associations with fear-avoidance beliefs: cross-sectional study among more than 10,000 wage earners of the general working population." Scandinavian Journal of Pain 18, no. 1 (January 26, 2018): 71–79. http://dx.doi.org/10.1515/sjpain-2017-0136.
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Abstract Background and aims: The association between different types of physical activity and fear-avoidance beliefs remains unclear. This study investigates the association between work-related and leisure-time physical activity with fear-avoidance beliefs in the general working population. Methods: Currently employed wage earners (n=10,427) from the 2010 round of the Danish Work Environment Cohort Study replied to questions about work, lifestyle and health. General linear models controlling for lifestyle, psychosocial work factors, education, pain, medication-use and chronic diseases tested associations of work-related and leisure-time physical activity (explanatory variables) with fear-avoidance beliefs (outcome variable, scale 0–100). Results: The level of fear-avoidance was 41.7 (SD 27.3), 38.0 (SD 26.9) and 54.3 (SD 27.7) among the general working population, a subgroup of pain-free individuals, and a subgroup with back disease, respectively. In the general working population, the level of fear-avoidance among those with low, moderate and high physical activity during leisure were 47 [95% confidence intervals (CI) 45–49], 44 (95% CI 42–46) and 43 (95% CI 41–45), and physical activity at work were 40 (95% CI 39–42), 44 (95% CI 42–46) and 49 (95% CI 48–51), respectively. Individuals with back disease and a high level of physical activity at work showed the overall highest level of fear-avoidance whereas pain-free individuals with a low level of physical activity at work showed the overall lowest level of fear-avoidance. Conclusions: Physical activity during work and leisure shows contrasting associations with fear-avoidance beliefs. While high physical activity during leisure is associated with lower levels, high physical activity at work is associated with higher levels of fear-avoidance. Implications: The present results may reflect some deeply rooted negative beliefs about pain and work in the population. On the societal level, campaigns may be a possible way forward as these have shown to improve beliefs about musculoskeletal pain and work.
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Dover, Geoffrey, and Vanessa Amar. "Development and Validation of the Athlete Fear Avoidance Questionnaire." Journal of Athletic Training 50, no. 6 (June 1, 2015): 634–42. http://dx.doi.org/10.4085/1062-6050-49.3.75.
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Context The fear-avoidance model was developed in an attempt to explain the process by which “pain experience” and “pain behavior” become dissociated from the actual pain sensation in individuals who manifest the phenomenon of exaggerated pain perception. High levels of fear avoidance can lead to chronic pain and disability and have successfully predicted rehabilitation time in the work-related–injury population. Existing fear-avoidance questionnaires have all been developed for the general population, but these questionnaires may not be specific enough to fully assess fear avoidance in an athletic population that copes with pain differently than the general population. Objective To develop and validate the Athlete Fear Avoidance Questionnaire (AFAQ). Design Qualitative research to develop the AFAQ and a cross-sectional study to validate the scale. Patients or Other Participants For questionnaire development, a total of 8 experts in the fields of athletic therapy, sport psychology, and fear avoidance were called upon to generate and rate items for the AFAQ. For determining concurrent validity, 99 varsity athletes from various sports participated. Data Collection and Analysis A total of 99 varsity athletes completed the AFAQ, the Fear-Avoidance Beliefs Questionnaire, and the Pain Catastrophizing Scale. We used Pearson correlations to establish concurrent validity. Results Concurrent validity was established with significant correlations between the AFAQ and the Fear Avoidance Beliefs Questionnaire-Physical Activity (r = 0.352, P > .001) as well as with the Pain Catastrophizing Scale (r = 0.587, P > .001). High internal consistency of our questionnaire was established with a Cronbach α coefficient of 0.805. The final version of the questionnaire includes 10 items with good internal validity (P < .05). Conclusions We developed a questionnaire with good internal and external validity. The AFAQ is a scale that measures sport-injury–related fear avoidance in athletes and could be used to identify potential psychological barriers to rehabilitation.
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San-Antolín, Marta, David Rodríguez-Sanz, Davinia Vicente-Campos, Patricia Palomo-López, Carlos Romero-Morales, María Benito-de-Pedro, Daniel López-López, and César Calvo-Lobo. "Fear Avoidance Beliefs and Kinesiophobia Are Presented in Athletes who Suffer from Gastrocnemius Chronic Myofascial Pain." Pain Medicine 21, no. 8 (January 31, 2020): 1626–35. http://dx.doi.org/10.1093/pm/pnz362.
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Abstract Objective To compare and predict kinesiophobia and fear avoidance beliefs between athletes with gastrocnemius myofascial pain syndrome (MPS) and healthy athletes. Design Case–control. Setting Outpatient clinic. Subjects Fifty athletes were divided into athletes with chronic gastrocnemius MPS (N = 25) and healthy athletes (N = 25). Methods Kinesiophobia symptoms total and domain scores (harm and activity avoidance) and levels were determined by the Tampa Scale of Kinesiophobia (TSK-11). Fear avoidance beliefs total and domain scores (physical and working activities) were measured by the Fear Avoidance Beliefs Questionnaire (FABQ). Results Significant differences (P < 0.05) with a large effect size (d = 0.81–4.22) were found between both groups, with greater kinesiophobia symptom scores for the TSK-11 activity avoidance domain and total scores, and greater fear avoidance beliefs scores for the FABQ physical and working activities domains and total scores of athletes with gastrocnemius MPS with respect to healthy athletes. TSK-11 total score showed a prediction model (R2 = 0.256) based on the FABQ total score. The FABQ total score showed a prediction model (R2 = 0.741) based on gastrocnemius MPS presence (R2 = 0.665), levels of kinesiophobia (R2 = 0.052), and height (R2 = 0.025). Conclusions Greater kinesiophobia levels, greater total and activity avoidance domain scores (but not for the harm domain), and greater fear avoidance beliefs total and domain scores (work and physical activity) were shown for athletes with gastrocnemius MPS vs healthy athletes. Higher kinesiophobia symptoms were predicted by greater fear avoidance beliefs in athletes. Greater fear avoidance beliefs were predicted by the presence of gastrocnemius MPS, higher levels of kinesiophobia, and lower height in athletes.
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Hunt, Emily R., Shelby E. Baez, Anne D. Olson, Timothy A. Butterfield, and Esther Dupont-Versteegden. "Using Massage to Combat Fear-Avoidance and the Pain Tension Cycle." International Journal of Athletic Therapy and Training 24, no. 5 (September 1, 2019): 198–201. http://dx.doi.org/10.1123/ijatt.2018-0097.
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Massage is a common therapeutic modality utilized by clinicians in a variety of settings to help treat injuries, reduce pain, and return function to patients. Massage benefits the patients both psychologically and physiologically, as patients report less pain and anxiety along with better mood and even decreased blood pressure following massage. Additionally, on the cellular level, massage has the ability to modulate the damaging inflammatory process and, in some cases, influence protein synthesis. Although massage has not been linked to a rehabilitation theory to date, this paper will propose how massage may influence fear-avoidance beliefs, or the patient’s inability to cope with pain that then leads to a pain tension cycle. Pain will often result in use avoidance, which creates muscle tension that further exacerbates the pain. Massage can affect the Fear-Avoidance Model because the beneficial effects of massage can break the cycle by either relieving the patient’s pain or eliminating the muscle tension. A modified Fear-Avoidance Model is presented that conceptualizes how pain and fear-avoidance lead to tension and muscle dysfunction. Massage has been incorporated into the model to demonstrate its potential for breaking the pain tension cycle. This model has the potential to be applied in clinical settings and provides an alternate treatment to patients with chronic pain who present with increased levels of fear-avoidance beliefs.
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Alaca, Nuray, Hande Kaba, and Ayce Atalay. "Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain." Journal of Back and Musculoskeletal Rehabilitation 33, no. 5 (September 17, 2020): 785–91. http://dx.doi.org/10.3233/bmr-171039.
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BACKGROUND AND OBJECTIVES: Low back pain (LBP) is one of the leading forms of chronic pain and is among the leading causes of pain and disability. In this study, we investigated the associations between the severity of disability and fear of movement and pain beliefs as well as the impact of the fear of movement and pain beliefs on the quality of life in patients with chronic LBP. METHODS: A total of 89 patients (42.29 ± 16.05 years) with chronic low back pain were included in the study. The instruments used in the assessments include the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), the Tampa Kinesiophobia Scale (TKS), the Pain Belief Questionnaire (PBQ), and the SF 36-Short Form. Patients were assigned into three groups by disability severity based on ODI scores. Statistical analysis was performed using SPSS 15. RESULTS: No statistically significant intergroup differences were found in TKS and PBQ scores (p> 0.05). A positive correlation was found between TKS scores, age (r: 0.227/p< 0.05), PBQ organic (r: -0.250/p< 0.05) scores. CONCLUSIONS: Our study revealed high levels of kinesiophobia and similar pain beliefs, independent of the severity level of disability. We believe that cognitive-behavioral therapy that may reduce fear-avoidance behaviors and convert negative pain beliefs into positive ones should be added to rehabilitation procedures for LBP.
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Steven, J. Linton, Nina Buer, Lars Samuelsson, and Karin Harms-Ringdahl. "Pain-related fear, catastrophizing and pain in the recovery from a fracture." Scandinavian Journal of Pain 1, no. 1 (January 1, 2010): 38–42. http://dx.doi.org/10.1016/j.sjpain.2009.09.004.
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AbstractBackground and aimsPain-related fear and catastrophizing are prominently related to acute and persistent back pain, but little is known about their role in pain and function after a fracture. Since fractures have a clear etiology and time point they are of special interest for studying the process of recovery. Moreover, fracture injuries are interesting in their own right since patients frequently do not recover fully from them and relatively little is known about the psychological aspects. We speculated that catastrophizing and fear-avoidance beliefs might be associated with more pain and poorer recovery after an acute, painful fracture injury.MethodsTo this end we conducted a prospective cohort study recruiting 70 patients with fractures of the wrist or the ankle. Participants completed standardized assessments of fear, pain, catastrophizing, degree of self-rated recovery, mobility and strength within 24 h of injury, and at 3- and 9-month follow-ups. Participants were also categorized as having high or low levels of fear-avoidance beliefs by comparing their scores on the first two assessments with the median from the general population. To consolidate the data the categorizations from the two assessments were combined and patients could therefore have consistently high, consistently low, increasing, or decreasing levels.ResultsResults indicated that levels of fear-avoidance beliefs and catastrophizing were fairly low on average. At the first assessment 69% of the patients expected a full recovery within 6 months, but in fact only 29% were fully recovered at the 9-month follow-up. Similarly, comparisons between the affected and non-affected limb showed that 71% of those with a wrist fracture and 58% with an ankle fracture were not fully recovered on grip strength and heel-rise measures. Those classified as having consistently high or increasing levels of fear-avoidance beliefs had a substantially increased risk of more intense future pain (adjusted OR = 3.21). Moreover, those classified as having consistently high or increasing levels of catastrophizing had an increased risk for a less than full recovery of strength by almost six-fold (adjusted OR = 5.87).Conclusions and implications This is the first investigation to our knowledge where the results clearly suggest that fear and catastrophizing, especially when the level increases, may be important determinants of recovery after an acute, painful, fracture injury. These results support the fear-avoidance model and suggest that psychological factors need to be considered in the recovery process after a fracture.
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Yudoyono, Farid. "Fear-Avoidance Beliefs in Chronic Cervical Zygapophyseal Joint Pain Relieve With Medial Branch Block." Neurologico Spinale Medico Chirurgico 1, no. 2 (August 7, 2018): 12. http://dx.doi.org/10.15562/nsmc.v1i2.90.
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Background: Chronic posterior neck pain is common, affecting 50–75% of people for 1 year or longer. The zygapophyseal joint is reported to be one of most common causative factors. The fear-avoidance is a model that describes how individuals develop chronic pain as a result of avoidant behaviour based on fear. Previous studies shown that medial branch block (MBB) and radio frequency neurotomy were effective for intractable pain.Material And Method: Case 1, TMK, Male, 57 yo, left posterior neck pain, VAS neck 7-8, NDI 46 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 2, RDW, Male, 45 yo, left posterior neck pain, VAS neck 8-9, NDI 40 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (63%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 3, TAY, Female, 52 yo, bilateral posterior neck pain, VAS neck 8-9, NDI 52 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI.Results: Our study reveals that C-MBB might ensure pain relief and decrease analgesic need. Physical activity at 1-, 3- and 6-months post-CMBB intervention were 65%, 60% and 68% of patients, respectively, gained >50% pain relief.Conclusion: Therapeutic MBB may provide an option for chronic high fear-avoidance beliefs pain of zygapophyseal joint.
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Jay, Kenneth, Sannie Vester Thorsen, Emil Sundstrup, Ramon Aiguadé, Jose Casaña, Joaquin Calatayud, and Lars Louis Andersen. "Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain." Pain Research and Treatment 2018 (September 2, 2018): 1–6. http://dx.doi.org/10.1155/2018/8347120.
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Background and Objective. Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence. Methods. Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up. Results. During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)). Conclusion. A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain.
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Westman, Anders E., Katja Boersma, Jerzy Leppert, and Steven J. Linton. "Fear-Avoidance Beliefs, Catastrophizing, and Distress." Clinical Journal of Pain 27, no. 7 (September 2011): 567–77. http://dx.doi.org/10.1097/ajp.0b013e318219ab6c.
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Godges, Joseph J., Marie A. Anger, Grenith Zimmerman, and Anthony Delitto. "Effects of Education on Return-to-Work Status for People With Fear-Avoidance Beliefs and Acute Low Back Pain." Physical Therapy 88, no. 2 (February 1, 2008): 231–39. http://dx.doi.org/10.2522/ptj.20050121.
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Background and PurposePeople with acute low back injury and fear-avoidance beliefs are at risk for remaining off work for an extended period of time. However, the effectiveness of intervention strategies for improving return-to-work status in people with acute low back pain and fear-avoidance beliefs has not been reported. The objective of this study was to determine whether education and counseling on pain management, physical activity, and exercise could significantly decrease the number of days that people with low back injury are off work.SubjectsThirty-four people who were unable to return to work following a work-related episode of low back pain and who exhibited fear-avoidance beliefs participated in this study.MethodsParticipants who scored 50 points or higher on the Fear-Avoidance Beliefs Questionnaire were alternately assigned to an education group or a comparison group. Both groups received conventional physical therapy intervention. Participants in the education group were given education and counseling on pain management tactics and the value of physical activity and exercise. The effectiveness of the interventions was measured by the number of days before people returned to work without restrictions.ResultsAll participants in the education group returned to regular work duties within 45 days. One third of the participants in the comparison group remained off work at 45 days. There was a statistically significant difference between the groups with regard to the number of days before returning to work.Discussion and ConclusionEducation and counseling regarding pain management, physical activity, and exercise can reduce the number of days off work in people with fear-avoidance beliefs and acute low back pain.
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Held, Sabine Melanie, Roman Rolke, Rolf-Detlef Treede, Kirsten Schmieder, Zohra Karimi, Sigrid Christa Sudhaus, and Monika Ilona Hasenbring. "Pain-Related Endurance, Fear-Avoidance and Somatosensory Sensitivity as Correlates of Clinical Status after Lumbar Disc Surgery." Open Pain Journal 6, no. 1 (May 30, 2013): 165–75. http://dx.doi.org/10.2174/1876386301306010165.
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Most pain and disability variance in patients with low back pain still remains unexplained. The aim of this study was to enhance the degree of explained variance by including measures of pain and tactile sensitivity as well as pain-related endurance and fear-avoidance responses. Thirty-six post lumbar disc surgery patients completed psychometric questionnaires (Avoidance-Endurance Questionnaire, Fear-Avoidance Beliefs Questionnaire, Beck Depression Inventory) and underwent quantitative sensory testing (QST) with measures of pain (pressure (PPT) and mechanical pain threshold) and tactile sensitivity (MDT). Bivariate correlations and hierarchical multiple regression analysis were computed. In addition to the contribution of fear-avoidance responses, pressure pain sensitivity and endurance behavior significantly contributed to explanations of pain variance, whereas disability was primarily predicted by fear-avoidance. While all psychological variables and MDT were positively related to pain or disability, PPT was negatively related to pain. The regression model accounted for 69 % of the variance in back pain intensity and 68 % of the variance in disability. Tactile hypaesthesia was related to increased clinical pain. Pain-related endurance responses and pressure pain hyperalgesia were significant additional predictors for pain, but not for disability. These findings are compatible with generalized disinhibition via descending pathways and a general inhibition of tactile acuity by ongoing pain.
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Rainville, James, Rob J. E. M. Smeets, Tom Bendix, Torill H. Tveito, Serge Poiraudeau, and Aage J. Indahl. "Fear-avoidance beliefs and pain avoidance in low back pain—translating research into clinical practice." Spine Journal 11, no. 9 (September 2011): 895–903. http://dx.doi.org/10.1016/j.spinee.2011.08.006.
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Lundberg, M., A. Grimby-Ekman, J. Verbunt, and M. J. Simmonds. "Pain-Related Fear: A Critical Review of the Related Measures." Pain Research and Treatment 2011 (November 15, 2011): 1–26. http://dx.doi.org/10.1155/2011/494196.
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Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.
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Javdaneh, Norollah, Atle Hole Saeterbakken, Arash Shams, and Amir Hossein Barati. "Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain." International Journal of Environmental Research and Public Health 18, no. 16 (August 22, 2021): 8848. http://dx.doi.org/10.3390/ijerph18168848.
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Background: Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. Objective: To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain–disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. Methods: This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear–Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. Results: For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). Conclusion: Therapeutic exercises combined with pain neuroscience education reduced the pain–disability index, pain catastrophizing, and fear–avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.
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Whibley, Daniel, Ross MacDonald, Gary J. Macfarlane, and Gareth T. Jones. "Constructs of health belief and disabling distal upper limb pain." Scandinavian Journal of Pain 13, no. 1 (October 1, 2016): 91–97. http://dx.doi.org/10.1016/j.sjpain.2016.07.003.
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AbstractBackgroundMusculoskeletal pain in the distal upper limb is common and is a cause of disability and healthcare consultation. At the time of presentation individuals reporting similar pain severities may report different levels of related disability. The biopsychosocial model proposes that health beliefs may help explain this difference. The aim of this cross-sectional study was to identify underlying constructs of health belief in those referred to physiotherapy with pain in the distal upper limb and investigate whether these constructs moderated the relationship between pain severity and extent of disability.MethodHealth beliefs were assessed using an instrument included in a questionnaire completed before randomisation to the Arm Pain Trial (ISRCTN79085082). Ordinal responses to statements about health beliefs were used to generate a polychoric correlation matrix. The output from this matrix was then used for Exploratory Factor Analysis to determine underlying constructs. The moderating influence of the identified health belief constructs was then tested using interaction terms in linear regression models.Results476 trial participants contributed data, age range 18–85 (mean 48.8, SD 13.7), 54% female. Five health belief constructs were identified: beliefs about hereditary factors, beliefs about movement and pain, beliefs about locus of control, beliefs about the role of lifecourse/lifestyle factors, and beliefs about prognosis. The only health belief construct found to moderate the pain-disability relationship was beliefs about prognosis, with greater pessimism resulting in higher levels of disability at mild-to-moderate levels of pain severity (B –0.17,95% CI –0.30, –0.036).ConclusionThis exploratory cross-sectional study identified five constructs of health belief from responses to a previously used set of statements investigating fear avoidance and illness beliefs in a clinical population with pain in the distal upper limb. Of these constructs, beliefs about prognosis were found to moderate the relationship between pain and disability.ImplicationsAt the time of referral to physiotherapy it may be beneficial to assess patients’ perception of prognosis. For those with higher than expected disability for the presenting level of pain, and pessimism about prognosis, focused reassurance may play an important part in initial consultation. Longitudinal study is required to support the findings from this study and investigate whether a causal relationship exists. Future investigations should confirm the health belief constructs proposed.
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Karlsson, Linn, Björn Gerdle, Esa-Pekka Takala, Gerhard Andersson, and Britt Larsson. "Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain." SAGE Open Medicine 4 (January 1, 2016): 205031211666893. http://dx.doi.org/10.1177/2050312116668933.
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Background: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments. Objectives: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not. Method: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4–6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not. Results: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial. Conclusion: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.
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Fujii, Tomoko, Ko Matsudaira, and Hiroyuki Oka. "Factors associated with fear-avoidance beliefs about low back pain." Journal of Orthopaedic Science 18, no. 6 (November 2013): 909–15. http://dx.doi.org/10.1007/s00776-013-0448-4.
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Buitenhuis, Jan, and Peter J. de Jong. "Fear Avoidance and Illness Beliefs in Post-Traumatic Neck Pain." Spine 36 (December 2011): S238—S243. http://dx.doi.org/10.1097/brs.0b013e3182388400.
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Waddell, Gordon, Mary Newton, Iain Henderson, Douglas Somerville, and Chris J. Main. "A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability." Pain 52, no. 2 (February 1993): 157–68. http://dx.doi.org/10.1016/0304-3959(93)90127-b.
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Norberg, M. "POS1273 A CHANGE IN A REHABILITATION MODEL INCREASES WORK CAPACITY AT 36 MONTHS IN LOW BACK PAIN." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 921.1–921. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1816.
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Background:In chronic low back pain, the most expensive patients are them with long-standing sick-leave of more than 6 months. Several studies have showed the importance of rehabilitation models working with kinesiophobia (fear of movement). One possibility of treating chronic low back pain is a multidisciplinary rehabilitation program.Objectives:The aim of this study was to analyze the impact of a change in a rehabilitation program for chronic lumbar pain by introducing a progressive exposure procedure to decrease apprehension associated with low back pain. We studied its impact on work capacity after 3 years, compared to our classic program.Methods:We have compared the results of 1004 of our patients that have accomplished a multi-disciplinary program and that have been followed over 12 months. They were divided in two groups: one before the implantation of PHODA (PHOto of Daily Activity: photos showing activites) associated with occupational training and work exposure. Then a second one including 200 patients that followed the new program. The program contained physical training, occupational tasks developed on the basis of the apprehension following a cogntivo-comportemental approach.We have analyzed the evolution of apprehension according to different questionnaires (FABQ, Tampa scale (TSK) and PACT (evaluating the subjective work capacity)), the Phoda results and the official work capacity at beginning of the program and after 36 months.Results:We saw a clear increase in the global work capacity at 12 months after completing the program: passing from 40 to 79% (p < 0.01) in the old program comparing to the new one with an increase of 86% (p< 0.01). These results were confirmed at 36 months, with stabilized results. In parallel there was an increase in the subjective sensation of physical capacity (Pact), but less in the new program. This increase was correlated with a decrease in fear-avoidance according to the Fabq, and in the TSKConclusion:In chronic low back, a multidisciplinary rehabilitation program, gives a global work capacity of 79%. This capacity could be increased on focalising on patient’s apprehensions with gradual exposure according the fear-avoidance model developed by Waddell and explored by Vlayen. The correlation were confirmed on the psychological part, with less apprehension and less anxiety.Finally, the SF 36 showed an increase in body confidence as an important factor in these functional restoration programs.References:[1]Waddell G et al. Low back pain, fear-avoidance beliefs and disability: With the development of a Fear-Avoidance Beliefs (FAB) questionnaire. Pain 1993;52:157-68[2]Vlaeyen JWS et al. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behaviour Res Therapy 2001;39(2):151–66[3]Waddell G et al. Low back pain, fear-avoidance beliefs and disability: With the development of a Fear-Avoidance Beliefs (FAB) questionnaire. Pain 1993;52:157-68[4]Vlaeyen JWS et al. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behaviour Res Therapy 2001;39(2):151–66Disclosure of Interests:None declared
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Sindhu, Bhagwant S., Leigh A. Lehman, Sergey Tarima, Mark D. Bishop, Dennis L. Hart, Matthew R. Klein, Mikesh Shivakoti, and Ying-Chih Wang. "Influence of Fear-Avoidance Beliefs on Functional Status Outcomes for People With Musculoskeletal Conditions of the Shoulder." Physical Therapy 92, no. 8 (May 24, 2012): 992–1005. http://dx.doi.org/10.2522/ptj.20110309.
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Background The influence of elevated fear-avoidance beliefs on change in functional status is unclear. Objective The purpose of this study was to determine the influence of fear-avoidance on recovery of functional status during rehabilitation for people with shoulder impairments. Design A retrospective longitudinal cohort study was conducted. Methods Data were collected from 3,362 people with musculoskeletal conditions of the shoulder receiving rehabilitation. At intake and discharge, upper-extremity function was measured using the shoulder Computerized Adaptive Test. Pain intensity was measured using an 11-point numerical rating scale. Completion rate at discharge was 57% for function and 47% for pain intensity. A single-item screen was used to classify patients into groups with low versus elevated fear-avoidance beliefs at intake. A general linear model (GLM) was used to describe how change in function is affected by fear avoidance in 8 disease categories. This study also accounted for within-clinic correlation and controlled for other important predictors of functional change in functional status, including various demographic and health-related variables. The parameters of the GLM and their standard errors were estimated with the weighted generalized estimating equations method. Results Functional change was predicted by the interaction between fear and disease categories. On further examination of 8 disease categories using GLM adjusted for other confounders, improvement in function was greater for the low fear group than for the elevated fear group among people with muscle, tendon, and soft tissue disorders (Δ=1.37, P<.01) and those with osteopathies, chondropathies, and acquired musculoskeletal deformities (Δ=5.52, P<.02). These differences were below the minimal detectable change. Limitations Information was not available on whether therapists used information on level of fear to implement treatment plans. Conclusions The influence of fear-avoidance beliefs on change in functional status varies among specific shoulder impairments.
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Poiraudeau, S., F. Rannou, G. Baron, Le A. Henanff, E. Coudeyre, S. Rozenberg, D. Huas, et al. "Fear-avoidance beliefs about back pain in patients with subacute low back pain." Pain 124, no. 3 (October 2006): 305–11. http://dx.doi.org/10.1016/j.pain.2006.04.019.
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George, Steven Z., Julie M. Fritz, and Daniel W. McNeil. "Fear-Avoidance Beliefs as Measured by the Fear-Avoidance Beliefs Questionnaire: Change in Fear-Avoidance Beliefs Questionnaire Is Predictive of Change in Self-Report of Disability and Pain Intensity for Patients With Acute Low Back Pain." Clinical Journal of Pain 22, no. 2 (February 2006): 197–203. http://dx.doi.org/10.1097/01.ajp.0000148627.92498.54.
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Stisen, Dorte Barfred, Heidi Tegner, Tom Bendix, and Bente Appel Esbensen. "The experience of patients with fear-avoidance belief hospitalised for low back pain – a qualitative study." Disability and Rehabilitation 38, no. 4 (April 20, 2015): 307–14. http://dx.doi.org/10.3109/09638288.2015.1037465.
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Coudeyre, Emmanuel, Florence Tubach, Francois Rannou, Gabriel Baron, Fernand Coriat, Sylvie Brin, Michel Revel, and Serge Poiraudeau. "Fear-avoidance Beliefs About Back Pain in Patients With Acute LBP." Clinical Journal of Pain 23, no. 8 (October 2007): 720–25. http://dx.doi.org/10.1097/ajp.0b013e31814da407.
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Petersen, Jonathan, Lilli Kirkeskov, Bjarke Brandt Hansen, Luise Moelenberg Begtrup, Esben Meulengracht Flachs, Mikael Boesen, Philip Hansen, Henning Bliddal, and Ann Isabel Kryger. "Physical demand at work and sick leave due to low back pain: a cross-sectional study." BMJ Open 9, no. 5 (May 2019): e026917. http://dx.doi.org/10.1136/bmjopen-2018-026917.
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ObjectivesTo investigate if self-reported high physical demand at work, objective physical workload using a job exposure matrix (JEM) and fear-avoidance beliefs are associated with reported sick leave in the previous year in persons with low back pain (LBP). Second, to investigate if the effects of fear-avoidance and self-reported high physical demand at work on sick leave are modified by the objective physical workloads.SettingsParticipants were recruited from general practice and by advertisement in a local newspaper.Participants305participants with a current period of 2–4 weeks LBP and self-reported difficulty in maintaining physically demanding jobs due to LBP were interviewed, clinically examined and had an MRI at baseline.Main outcome measuresIndependent variables were high fear-avoidance, self-reported high physical demand at work and objective measures of physical workloads (JEM). Outcome was self-reported sick leave due to LBP in the previous year. Logistic regression and tests for interaction were used to identify risk factors and modifiers for the association with self-reported sick leave.ResultsSelf-reported physically demanding work and high fear-avoidance were significantly associated with prior sick leave due to LBP in the previous year with OR 1.75 95% CI (1.10 to 2.75) and 2.75 95% CI (1.61to 4.84), respectively. No objective physical workloads had significant associations. There was no modifying effect of objective physical workloads on the association between self-reported physical demand at work/high fear-avoidance and sick leave.ConclusionsOccupational interventions to reduce sick leave due to LBP may have to focus more on those with high self-reported physical demands and high fear-avoidance, and less on individuals with the objectively highest physical workload.Trial registration numberNCT02015572; Post-results.
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Kaka, Bashir, Omoyemi O. Ogwumike, Samuel O. Ogunlade, and Ade F. Adeniyi. "Effects of neck stabilization and dynamic exercises on pain, disability and fear avoidance beliefs in patients with non-specific neck pain; a randomized clinical trial." Archives of Physiotherapy and Global Researches 19, no. 3 (September 1, 2015): 17–29. http://dx.doi.org/10.15442/apgr.19.2.14.
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Hekmatfard, Maryam, Mohammad Ali Sanjari, Nader Maroufi, Hassan Saeedi, Esmail Ebrahimi, and Hamid Behtash. "A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?" Asian Spine Journal 11, no. 5 (October 31, 2017): 748–55. http://dx.doi.org/10.4184/asj.2017.11.5.748.
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<sec><title>Study Design</title><p>Clinical pilot study.</p></sec><sec><title>Purpose</title><p>To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.</p></sec><sec><title>Overview of Literature</title><p>Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.</p></sec><sec><title>Methods</title><p>Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.</p></sec><sec><title>Results</title><p>The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (<italic>p</italic>=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (<italic>p</italic><0.001, <italic>p</italic>=0.02, respectively).</p></sec><sec><title>Conclusions</title><p>The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.</p></sec>
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Pfingsten, M., E. Leibing, Carmen Franz, Dorothea Bansemer, Olivia Busch, and J. Hildebrandt. "Erfassung der „fear-avoidance-beliefs” bei Patienten mit Rückenschmerzen." Der Schmerz 11, no. 6 (December 12, 1997): 387–95. http://dx.doi.org/10.1007/s004820050114.
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Rostami, Mohsen, Negin Noorian, Mohammad Ali Mansournia, Elham Sharafi, Amir Eslami Shahr Babaki, and Ramin Kordi. "Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain." Journal of Back and Musculoskeletal Rehabilitation 27, no. 2 (April 1, 2014): 213–21. http://dx.doi.org/10.3233/bmr-130439.
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Arnold, Jennifer, and Jonathan Santana. "FEAR AVOIDANCE BELIEFS RELATED TO PROLONGED RECOVERY FROM PEDIATRIC SPORTS CONCUSSIONS." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0023. http://dx.doi.org/10.1177/2325967120s00236.
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Background: Individuals experiencing persistent pain or discomfort may develop avoidance behaviors and fear. Fear avoidance behaviors have been found to be predictive of chronic disability in adults with neck and low back pain. These behaviors were found to be predictive of symptom severity and disability in adults with mild traumatic brain injury. To our knowledge there has been no research examining this correlation in the pediatric population. Hypothesis/Purpose: To evaluate whether pediatric patients who had prolonged recovery from a concussion presented with greater fear avoidance behaviors, as measured by the Fear of Pain Questionnaire (FoPQ). Methods: Patients, ages 8 to 17 years old, diagnosed with a concussion and presenting within 2 weeks of the initial injury to sports medicine clinic were included in this study. Individuals were excluded if the mechanism of injury was a motor vehicle accident or assault. Participants who consented were administered a FoPQ at their initial visit. The FoPQ, which has been validated in the pediatric population, contains 24 questions rated on a 5 point Likert scale. Patient’s length of recovery, vestibular ocular motor screen (VOMS) score, and post-concussion symptoms scale score (PCSS) were also recorded. Results: From September 2018-May 2019, a total of 82 patients consented for the study. Out of the total number, 44 were female and 38 were male, with an average age of 14 years ( SD = 2.2). Patients who had prolonged recovery (> 28 days) had similar FoPQ scores ( M = 30.06, SD = 16.6) to those with normal recovery ( M = 31.35 SD = 19.1). No significant correlation was found between days to recovery and FoPQ score, r(67) = .05 , p = .668. Patients found to have a positive VOMS (79% of patients) at initial visit took longer to recover by 24.96 days, t(61.65) = -4.26, p < .001 when compared to those with a negative screen. A positive VOMS screen did not correlate with higher fear avoidance score t(21.71) = -.61, p = .550. PCSS severity positively correlated to days to recovery r(67) = .26, p = .037. Conclusion: Based on preliminary study results we found no correlation between fear avoidance beliefs and time to recover from sports concussions in a pediatric population. Our data did support previous findings that PCSS severity scores and positive VOMS were predictive of prolonged recovery from a concussion. We will continue to collect data in line with our a priori power analysis (n=200).
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Kowal, John, Keith G. Wilson, Celia M. Geck, Peter R. Henderson, and Joyce L. D’Eon. "Changes in Perceived Pain Severity during Interdisciplinary Treatment for Chronic Pain." Pain Research and Management 16, no. 6 (2011): 451–56. http://dx.doi.org/10.1155/2011/817816.
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Biopsychosocial approaches to the treatment of chronic pain are founded on the principles of cognitive behavioural therapy, the basic aims of which are, among others, to identify and modify beliefs, decrease pain-related fear and avoidance of activity, and to teach adaptive coping strategies. To determine whether functional outcomes in multiple domains are improved in such settings, this retrospective study investigated patients’ reports of increased pain severity while participating in an interdisciplinary cognitive behavioural therapy-oriented outpa-tient treatment program.
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Saito, M., and Y. Nishida. "Effects of fear-avoidance beliefs on low back pain in Japanese nurses." Physiotherapy 101 (May 2015): e1317-e1318. http://dx.doi.org/10.1016/j.physio.2015.03.1241.
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Olsson, C., N. Buer, K. Holm, and L. Nilsson-Wikmar. "Lumbopelvic Pain Associated With Catastrophizing and Fear-avoidance Beliefs in Early Pregnancy." Obstetric Anesthesia Digest 30, no. 1 (March 2010): 33–34. http://dx.doi.org/10.1097/01.aoa.0000367016.88040.8b.
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Olsson, Christina, Nina Buer, Kerstin Holm, and Lena Nilsson-Wikmar. "Lumbopelvic pain associated with catastrophizing and fear-avoidance beliefs in early pregnancy." Acta Obstetricia et Gynecologica Scandinavica 88, no. 4 (January 2009): 378–85. http://dx.doi.org/10.1080/00016340902763210.
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Grotle, Margreth, Nina K. Vøllestad, and Jens I. Brox. "Clinical Course and Impact of Fear-Avoidance Beliefs in Low Back Pain." Spine 31, no. 9 (April 2006): 1038–46. http://dx.doi.org/10.1097/01.brs.0000214878.01709.0e.
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Terho, Henri, Marianne Haapea, Markus Paananen, Katariina Korniloff, Arja Häkkinen, and Jaro Karppinen. "Translation and validation of the Finnish version of the Fear-Avoidance Beliefs Questionnaire (FABQ)." Scandinavian Journal of Pain 10, no. 1 (January 1, 2016): 113–18. http://dx.doi.org/10.1016/j.sjpain.2015.09.003.
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AbstractBackground and aimLow back pain (LBP) is a debilitating problem worldwide causing disability and reducing quality of life. The Fear Avoidance Beliefs Questionnaire (FABQ) was developed on the basis of the assumption that fear-avoidance beliefs play a major role in LBP-related disability. It comprises 16 items scored by the patient and includes sub-scores for fear-avoidance beliefs regarding work and physical activity. This study aimed to translate and validate the Finnish version of the FABQ and to measure its properties among Finnish patients with LBP.Material and methodsA forward-backward translation procedure was used based on modified recommended guidelines. The FABQ was applied to 66 Finnish patients with LBP. Patients answered the FABQ at baseline and again approximately two weeks later. The test-re-test reliability between the baseline and follow-up FABQwas evaluated by calculating intraclass correlation coefficients (ICC). Internal consistency between the items within total and sub-scores was evaluated by calculating Cronbach’s alpha. The items of the baseline FABQ were grouped using factor analysis and the correlations between the FABQ pain intensity in visual analogue scale (VAS) and Oswestry Disability Index (ODI) were assessed using linear regression analysis.ResultsThe Finnish version of the FABQ was successfully adapted. The mean age of patients was 46. Almost all patients (97%) reported LBP, most patients (76%) had chronic pain lasting more than 3 months and the mean intensity of LBP was 58 mm on VAS. The follow-up time between the first and second questionnaire ranged from 2 days to 59 days with the median of 16 days. The ICC value for reliability between the baseline and follow-up questionnaires was excellent for the total score (0.91) and work sub-score (0.89), and good for the physical activity sub-score (0.73). The items regarding work showed high or excellent reliability throughout, with ICC values ranging from 0.63 to 0.89. The ICC values for the items related to physical activity ranged from 0.43 to 0.66, displaying moderate to good reliability. Cronbach’s alpha for internal consistency was excellent for the total score (0.92) and work (0.89), and good for physical activity (0.71). The best factor analysis solution yielded three factors characterized by the fear that pain aggravates due to (1) work or (2) physical activity, and (3) fear-avoidance beliefs concerning work. Higher total FABQ score was associated significantly with higher VAS (p-value 0.021) and ODI (<0.001).Conclusion and implicationsThe expert committee successfully created an applicable Finnish versionof the FABQ. The Finnish FABQ is a valid and reliable instrument for assessing LBP patients’ fear avoidancebehaviour and has similar properties to those found in other validation studies of the FABQ. Thus it canbe used for assessing the risk of disability due to fear avoidance behaviour in Finnish-speaking patientswith LBP for both clinical and scientific purposes.
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Fritz, Julie M., and Steven Z. George. "Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs." Physical Therapy 82, no. 10 (October 1, 2002): 973–83. http://dx.doi.org/10.1093/ptj/82.10.973.
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Abstract Background and Purpose. Psychosocial factors are known to affect recovery from acute low back pain. The factors with the greatest influence and the optimal methods of measurement and interpretation have not been established. The purpose of this study was to examine baseline psychosocial variables and their ability to predict prolonged work restrictions. Subjects. The subjects were 78 people with work-related low back pain who were participating in a clinical trial (mean age=37.4 years, SD=10.4, range=18–58; mean duration of pain=5.5 days, SD=4.6, range=0–19). Methods. A baseline examination including measures of impairment, disability, and psychosocial variables was performed. All subjects had physical therapy interventions. Work status was assessed after 4 weeks. Sensitivity, specificity, and likelihood ratios were calculated for the prediction of work status by the use of psychosocial variables. Receiver operator characteristic curves and logistic regression were used to identify the variables that were most predictive of work status. Results. Twenty-two subjects (29%) had persistent work restrictions. The work subscale of the Fear-Avoidance Beliefs Questionnaire was the strongest predictor of work status (negative likelihood ratio of 0.08 for scores less than 30, positive likelihood ratio of 3.33 for scores greater than 34). Discussion and Conclusion. Fear-avoidance beliefs about work was the psychosocial factor that could best be used to predict return to work in patients with acute work-related low back pain. Examination of fear-avoidance beliefs may serve as a useful screening tool for identifying patients who are at risk for prolonged work restrictions.
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Mbada, Chidozie Emmanuel, Joshua Oluwafunmibi Ojo, Opeyemi Ayodiipo Idowu, Taofik Oluwasegun Afolabi, Aanuoluwapo Deborah Afolabi, Kayode Israel Oke, Oluwatobi Ademola Sonuga, Sven Karstens, and Francis Fatoye. "Convergent and known group validity of the STarT Back Tool in a Nigerian population with chronic low back pain." physioscience 17, no. 02 (March 29, 2021): 75–81. http://dx.doi.org/10.1055/a-1250-4832.
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Abstract Background The STarT Back Tool (SBT) was developed to aid the stratification of patients with low-back pain (LBP), based on future risks for physical disability. Objective Investigation of the convergent and known group validity of the SBT in a Nigerian population with chronic LBP using disability-related psychosocial outcomes. Method Cross-sectional study involved 30 consenting patients with chronic LBP in an outpatient physiotherapy clinic of a tertiary health institution in Nigeria. Future risk of disability was assessed using the SBT. Psychosocial variables of pain catastrophizing, fear-avoidance beliefs (FAB), and kinesiophobia were assessed using the Pain Catastrophizing Scale, the Fear-Avoidance Beliefs Questionnaire and the Tampa Scale of Kinesiophobia, respectively. Data was analysed using percentages and Spearman correlation. Results Based on the SBT, there were rates of 43.3 % and 23.3 % for low and high future risks of physical disability. The median score of pain catastrophizing was 13.5, that of FAB came in at 16.5 related to physical activity and 14.0 related to work, and the score for kinesiophobia amounted to 39. The SBT total scores moderately correlated with the FAB related to work (rho = 0.45 (95 % CI 0.09–0.700). FAB related to physical activity (p = 0.040) significantly differed across the SBT subgroups. Conclusion The SBT and the other psychosocial instruments used in this study did not correlate to a sufficient degree. In addition, patients exhibiting catastrophizing, fear-avoidance beliefs, or kinesiophobia could not be differentiated based on SBT risk groups. The results should be interpreted with caution until findings from additional studies with sufficient sample sizes are at hand.
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Ibrahim, Aminu A., Mukadas O. Akindele, Bashir Kaka, and Bashir Bello. "Translation, cross-cultural adaptation, and psychometric properties of the Hausa version of the Fear-Avoidance Beliefs Questionnaire in patients with low back pain." Scandinavian Journal of Pain 19, no. 1 (January 28, 2019): 83–92. http://dx.doi.org/10.1515/sjpain-2018-0303.
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Abstract Background and aims The Fear-Avoidance Beliefs Questionnaire (FABQ) is the most widely used self-reported measure of fear-avoidance beliefs about work and physical activity in low back pain (LBP). However, there is no Hausa version for use in patients with LBP. This study aimed to translate, cross-culturally adapt, and test the psychometric properties of the Hausa version of the FABQ in patients with LBP. Methods The Hausa form of FABQ was developed using a forward-backward translation procedure according to recommended guidelines. The pre-final version of the questionnaire was pre-tested on 10 patients with acute LBP and 10 patients with chronic LBP. Psychometric testing was performed in 70 patients with acute LBP and 130 patients with chronic LBP. Reliability was assessed using internal consistency (Cronbach α) and test-retest reliability through intraclass correlation coefficient (ICC). Construct validity was assessed by exploratory factor analysis and divergent validity (Spearman rank correlation coefficient). Responsiveness was also investigated on 40 patients with chronic LBP. Results The Hausa version of the FABQ was successfully translated and proved to be well-understood. The internal consistency was adequate for the questionnaire (0.773) and its physical activity (0.816) and work (0.606) subscales. Test-retest reliability was excellent with an ICC value of 0.928 for the questionnaire and values of 0.901 and 0.863 for the physical activity and work subscales, respectively. Exploratory factor analysis yielded a three-factor structure in both acute and chronic LBP samples explaining 66.4% and 58.6% of the total variance, respectively. The first factor represents fear-avoidance beliefs due to work, the second factor represents fear-avoidance beliefs due to physical activity whereas the third factor represents the fear that pain aggravates due to work. Divergent validity showed moderate to weak correlation between the questionnaire and pain intensity (r=0.502), disability (r=0.415), lumbopelvic motion (r=0.00). The physical activity and work subscales weakly correlated (r=0.280). The effect size and standardized response mean were moderate to small with the work subscale having the lowest effect size (0.34) and standardized response mean (0.34) values. The MDC of the questionnaire was 5.4 points. The questionnaire had no ceiling or floor effects. Conclusions The FABQ was successfully translated into Hausa and cross-culturally adapted with acceptable psychometric properties similar to those of existing versions. The results suggest that the Hausa FABQ can be used to evaluate fear-avoidance beliefs about LBP in Hausa-speaking population for both clinical and research purposes.