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The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain



This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability.


Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability.


A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability.


Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

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This research was supported by grants from the Spanish Ministry of Science and Innovation (PSI2008-01803/PSIC) and the Andalusian Regional Government (HUM-566; P07-SEJ-3067).

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Correspondence to C. Ramírez-Maestre.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ramírez-Maestre, C., Esteve, R., Ruiz-Párraga, G. et al. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain. Int.J. Behav. Med. 24, 239–248 (2017).

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  • Acute pain
  • Anxiety sensitivity
  • Fear-avoidance beliefs
  • Catastrophizing
  • Resilience
  • Disability