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The role of fear of movement/(re)injury in pain disability

Abstract

It is now well established that in chronic low back pain, there is no direct relationship between impairments, pain, and disability. From a cognitive-behavioral perspective, pain disability is not only influenced by the organic pathology, but also by cognitive-perceptual, psychophysiological, and motoric-environmental factors. This paper focuses on the role of specific beliefs that are associated with avoidance of activities. These beliefs are related to fear of movement and physical activity, which is (wrongfully) assumed to cause (re)injury. Two studies are presented, of which the first examines the factor structure of the Tampa Scale for Kinesiophobia (TSK), a recently developed questionnaire that is aimed at quantifying fear of movement/(re)injury. In the second study, the value of fear of movement/(re)injury in predicting disability levels is analyzed, when the biomedical status of the patient and current pain intensity levels are controlled for. In addition, the determinants of fear of movement/(re)injury are examined. The discussion focuses on the clinical relevance of the fear-avoidance model in relation to risk assessment, assessment of functional capacity, and secondary prevention.

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References

  1. 1.

    Spitzer WO, LeBlanc FE, Dupuis M. Scientific approach to the assessment and management of activity-related spinal disorders: Report of the Quebec task Force on Spinal Disorders.Spine 1987; 12 (Suppl. 7): S1-S59.

    PubMed  Google Scholar 

  2. 2.

    Crook J, Moldofsky H. The probability of recovery and return to work from work disability as a function of time.Quality Life Res 1994; 3 (Suppl. 1): 97–109.

    Google Scholar 

  3. 3.

    Nachemson AL. Newest knowledge of low back pain.Clin Orthop 1992; 279: 8–20.

    PubMed  Google Scholar 

  4. 4.

    Fordyce WE.Behavioral methods for chronic pain and illness. St. Louis: Mosby, 1976.

    Google Scholar 

  5. 5.

    Fordyce WE, Shelton JL, Dundore DE. The modification of avoidance learning in pain behaviors.J Behav Med 1982; 5: 405–414.

    PubMed  Google Scholar 

  6. 6.

    Waddell G. A new clinical model for the treatment of low back pain.Spine 1987; 12: 632–644.

    PubMed  Google Scholar 

  7. 7.

    Waddell G, Main CJ, Morris EW, DiPaola MP, Gray ICM. Chronic low back pain, psychologic distress and illness behaviour.Spine 1984; 9: 209–213.

    PubMed  Google Scholar 

  8. 8.

    Turk DC, Meichenbaum D, Genest M.Pain and behavioral medicine. A cognitive-behavioral perspective. New York: Guilford Press, 1983.

    Google Scholar 

  9. 9.

    Deyo R, Diehl A, Rosenthal M. How many days of bed rest for acute low back pain?New Engl J Med 1986; 315: 1064–1070.

    PubMed  Google Scholar 

  10. 10.

    Philips HC, Grant L. The prevention of chronic pain and disability: A preliminary investigation.Behav Res Ther 1991; 29: 443–450.

    PubMed  Google Scholar 

  11. 11.

    Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atkinson LE, Troup JDG, Rose MJ. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting.Spine 1995; 4: 478–484.

    Google Scholar 

  12. 12.

    Vlaeyen JWS, Snijders AMJ, Schuerman JA, van Eek H, Groenman NH, Bremer JJCB. Chronic pain and the three-systems model of emotions. A critical examination.Crit Rev Phys Reh Med 1989; 2: 67–76.

    Google Scholar 

  13. 13.

    Flor H, Birbaumer N, Turk DC. The psychobiology of chronic pain.Adv Behav Res Ther 1990; 121: 47–84.

    Google Scholar 

  14. 14.

    Feuerstein M. A multidisciplinary approach to the prevention, evaluation, and management of work disability.J Occup Rehab 1991; 1: 5–12.

    Google Scholar 

  15. 15.

    Pilowsky I. Pain and illness behaviour: Assessment and management. In: Wall PD, Melzack R, eds.Textbook of pain. Edinburgh: Churchill Livingstone, 1994.

    Google Scholar 

  16. 16.

    Cioffi D. Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation.Psychol Bull 1991; 109: 25–41.

    PubMed  Google Scholar 

  17. 17.

    Ciccone DS, Grzesiak RC. Cognitive dimensions of chronic pain.Soc Sci Med 1984; 12: 1339–1345.

    Google Scholar 

  18. 18.

    Kazdin AE.Behavior modification in applied settings, revised Ed. Homewood, Illinois: Dorsey Press 1980.

    Google Scholar 

  19. 19.

    Kanfer FH, Phillips JS.Learning foundations of behavior therapy. New York: Wiley & Sons, 1970.

    Google Scholar 

  20. 20.

    Bortz WM. The disuse syndrome.West J Med 1984; 141: 691–694.

    PubMed  Google Scholar 

  21. 21.

    Philips HC, Jahanshahi M. The components of pain behaviour report.Behav Res Ther 1986; 24: 117–125.

    PubMed  Google Scholar 

  22. 22.

    Philips HC. Avoidance behaviour and its role in sustaining chronic pain.Behav Res Ther 1987; 25: 273–279.

    PubMed  Google Scholar 

  23. 23.

    Lethem J, Slade PD, Troup JDG, Bentley G. Outline of a fear-avoidance model of exaggerated pain perceptions.Behav Res Ther 1983; 21: 401–408.

    PubMed  Google Scholar 

  24. 24.

    McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain.Pain 1992; 50: 67–73.

    PubMed  Google Scholar 

  25. 25.

    McCracken LM, Gross RT. Does anxiety affect coping with pain?Clin J Pain 1993; 9: 253–259.

    PubMed  Google Scholar 

  26. 26.

    Waddell G, Newton M, Henderson I, Somerville D, Main C. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain 1993; 52: 157–168.

    PubMed  Google Scholar 

  27. 27.

    Kori SH, Miller RP, Todd DD. Kinisophobia: A new view of chronic pain behavior.Pain Management 1990; Jan/Feb: 35–43.

    Google Scholar 

  28. 28.

    Kole-Snijders AMJ, Vlaeyen JWS, Boeren RGB, Schuerman JA, Eek van H. Validity of the Tampa Scale for Kinisophobia-Dutch version (TSK-DV) for chronic low back pain patients.Paper presented at the 7th World Congress on Pain, August 22–27, 1993, Paris.

  29. 29.

    Crombez G.Pijnmodulatie Door Anticipatie (Painmodulation Through Anticipation). Doctoral dissertation, University of Leuven, Belgium, 1994.

    Google Scholar 

  30. 30.

    Rose M, Klenerman L, Atchinson L, Slade PD. An application of the fear-avoidance model to three chronic pain problems.Behav Res Ther 1992; 30: 359–365.

    PubMed  Google Scholar 

  31. 31.

    Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment.Pain 1983; 17: 33–44.

    PubMed  Google Scholar 

  32. 32.

    McCracken LM, Gross RT, Sorg PJ, Edmands TA. Prediction of pain in patients with chronic low back pain: Effects of inaccurate prediction and pain-related anxiety.Behav Res Ther 1993; 31: 647–652.

    PubMed  Google Scholar 

  33. 33.

    Vlaeyen JWS. Chronic Low Back Pain.Assessment and Treatment from a Behavioral Rehabilitation Perspective. Doctoral dissertation. University of Limburg, Maastricht, The Netherlands, 1991.

    Google Scholar 

  34. 34.

    Wolpe J, Lang PJ. A fear schedule for use in behavior therapy.Behav Res Ther 1964; 2: 27–30.

    Google Scholar 

  35. 35.

    Arrindell WA, Solyom C, Ledwidge B, Van der Ende J, Hageman WJJM, Solyom L, Zaitman A. Cross-national validity of the five-components model of self-assessed fears: Canadian psychiatric outpatients data vs Dutch target ratings on the Fear Survey Schedule-Ill.Adv Behav Res Ther 1990; 12: 101–122.

    Google Scholar 

  36. 36.

    Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance.Pain 1995; 62: 363–372.

    PubMed  Google Scholar 

  37. 37.

    Melzack R. The McGill Pain Questionnaire. Major properties and scoring methods.Pain 1975; 1: 277–299.

    PubMed  Google Scholar 

  38. 38.

    Van der Kloot WA, Vertommen H.De MPQ-DLV. Een standaard Nederlandstalige versie van de McGill Pain Questionnaire. Achtergronden en handleiding. Lisse: Swets & Zeitlinger, 1989.

    Google Scholar 

  39. 39.

    Vlaeyen JWS, Geurts SM, Kole-Snijders AMJ, Schuerman JA, Groenman NH, van Eek H. What do chronic pain patients think of their pain? Towards a pain cognition questionnaire.Brit J Clin Psychol 1990; 29: 383–394.

    Google Scholar 

  40. 40.

    Spinhoven Ph, Linssen ACG. Behavioral treatment of chronic low back pain. Relation to coping strategy use to outcome.Pain 1991; 45: 29–34.

    PubMed  Google Scholar 

  41. 41.

    Rudy TR, Turk DC, Brena SF, Stieg RL, Brody MC. Quantification of biomedical findings of chronic pain patients: Development of an index of pathology.Pain 1990; 42: 167–182.

    PubMed  Google Scholar 

  42. 42.

    Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, eds.Handbook of pain assessment. New York: Guilford Press, 1992.

    Google Scholar 

  43. 43.

    Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low back pain.Spine 1983; 8: 141–144.

    PubMed  Google Scholar 

  44. 44.

    Rotteveel A. Fear of pain or pain as a consequence of fear. The role of kinesiophobia in the maintenance of chronic pain. Unpublished manuscript, 1995.

  45. 45.

    Wall PD. On the relation of injury to pain.Pain 1979; 6: 253–264.

    PubMed  Google Scholar 

  46. 46.

    Turk DC, Holzman AD. Chronic pain: Interfaces among physical, psychological and social parameters. In: Holzman AD, Turk, DC, eds.Pain management. A handbook of psychological treatment approaches. New York: Pergamon, 1986.

    Google Scholar 

  47. 47.

    Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble.Spine 1995; 20: 722–728.

    PubMed  Google Scholar 

  48. 48.

    Council JR, Ahern DK, Follick MJ, Kline CL. Expectancies and functional impairment in chronic low back pain.Pain 1988; 33: 323–331.

    PubMed  Google Scholar 

  49. 49.

    Romano JM, Turner JA. Chronic pain and depression. Does the evidence support a relationship?Psychol Bull 1985; 97: 18–34.

    PubMed  Google Scholar 

  50. 50.

    McQuade KJ, Turner JA, Buchner DM. Physical fitness and chronic low back pain.Clin Orthop Rel Res 1988; 233: 198–204.

    Google Scholar 

  51. 51.

    Gamsa A. Is emotional disturbance a precipitator or a consequence of chronic pain?Pain 1990; 42: 183–195.

    PubMed  Google Scholar 

  52. 52.

    Menard MR, Cooke C, Locke SR, Beach GN, Butler TB. Pattern of performance in workers with low back pain during a comprehensive motor performance evaluation.Spine 1994; 2: 1359–1366.

    Google Scholar 

  53. 53.

    Bandura A. Self-efficacy: Toward a unifying theory of behavioral change.Psychol Rev 1977; 84: 191–215.

    PubMed  Google Scholar 

  54. 54.

    Butler G. Phobic disorders. In: Hawtonet al., eds.Cognitive behaviour therapy for psychiatric problems. A practical guide. Oxford: Oxford Medical Publications, 1989.

    Google Scholar 

  55. 55.

    Lindström I, öhlund C, Eek C, Wallin L, Peterson L, Fordyce WE, Nachemson AL. The effect of graded activity on patients with sub-acute low back pain: A randomized prospective clinical study with an operant conditioning behavioral approach.Phys Ther 1992; 72: 279–290.

    PubMed  Google Scholar 

  56. 56.

    Linton SJ. Chronic pain: The case for prevention.Behav Res Ther 1987; 4: 313–317.

    Google Scholar 

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Correspondence to Johan W. S. Vlaeyen.

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Vlaeyen, J.W.S., Kole-Snijders, A.M.J., Rotteveel, A.M. et al. The role of fear of movement/(re)injury in pain disability. J Occup Rehab 5, 235–252 (1995). https://doi.org/10.1007/BF02109988

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Key words

  • chronic low back pain
  • fear-avoidance
  • fear of movement
  • fear of (re)injury
  • fear of pain
  • kinesiophobia
  • behavioral assessment