Journal of Occupational Rehabilitation

, Volume 10, Issue 3, pp 215–227 | Cite as

Activity Avoidance and Function in Persons with Chronic Back Pain

  • Michael E. Geisser
  • Andrew J. Haig
  • Mary E. Theisen


This study examined the relative contribution of two aspects of pain-related fear to functional disability among 133 persons with chronic pain, predominantly chronic back pain: 1) beliefs that pain represents damage or significant harm to the body and 2) beliefs that activities that cause pain should be avoided. Pain-related fear was assessed using the Tampa Scale for Kinesiophobia, Version 2 (TSK-2). Factor analysis in the present study replicated the two-factor solution found in a previous investigation, representing the two dimensions of pain-related fear noted above. Activity avoidance was significantly associated with the percent of maximum expected weight lifted from floor to waist and waist to shoulder during Progressive Isoinertial Lifting Evaluation (PILE). Fear of damage or harm to the body was only significantly related to the floor to waist lift. When controlling for demographic, physiologic, and other psychological variables, only activity avoidance continued to significantly predict performance on both lifts of the PILE. Although it has been proposed that deconditioning may mediate the relationship between activity avoidance and disability, this was not supported in the present investigation. The results highlight the importance of pain-related fear, particularly activity avoidance, in the assessment of functional activity among persons with chronic pain.

chronic pain back pain disability pain-related fear activity avoidance 


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  1. 1.
    Hill HE, Belleville RE, Wikler A. Studies on anxiety associated with anticipation of pain. Arch Neurol Psychiat 1955; 73: 602–608.Google Scholar
  2. 2.
    Kori SH, Miller RP, Todd DD. Kinesiophobia: A new view of chronic pain behavior. Pain Manag 1990; 3: 35–43.Google Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Philips HC. Avoidance behavior and its role in sustaining chronic pain. Behav Res Ther 1987; 25: 273–279.Google Scholar
  5. 5.
    Crombez G, Vervaet L, Baeyens F, Lysens R, Eelen P. Do pain expectancies cause pain in chronic low back patients? A clinical investigation. Behav Res Ther 1996; 34: 919–925.Google Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    Flor H, Turk DC. Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables. J Behav Med 1988; 11: 251–265.Google Scholar
  8. 8.
    Geisser ME, Roth RS. Knowledge of and agreement with pain diagnosis: Relation to pain beliefs, pain severity, disability, and psychological distress. J Occup Rehabil 1998; 8: 73–88.Google Scholar
  9. 9.
    Millard RW, Wells N, Thebarge RW. A comparison of models describing reports of disability associated with chronic pain. Clin J Pain 1991; 7: 283–291.Google Scholar
  10. 10.
    Vlaeyen JWS, Kole-Snijders AJM, Rotteveel AM, Ruesink R, Heuts PHTG (1995). The role of fear of movement/(re)injury in pain disability. J Occup Rehabil 1995; 5: 235–252.Google Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    Jensen MP, Turner JA, Romano JM, Lawler BK. Relationship of pain specific beliefs to chronic pain adjustment. Pain 1994; 57: 301–309.Google Scholar
  13. 13.
    Asmundson GJG, Norton GR, Allerdings MD. Fear and avoidance in dysfunctional chronic back pain patients. Pain 1997; 69: 231–236.Google Scholar
  14. 14.
    McCracken LM, Spertus IL, Janeck AS, Sinclair D, Wetzel FT. Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain 1999; 80: 283–289.Google Scholar
  15. 15.
    Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985; 23: 345–356.Google Scholar
  16. 16.
    Jensen MP, Turner JA, Romano JM. (1994). Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 1994; 62: 172–179.Google Scholar
  17. 17.
    McCracken LM, Gross RT. The role of pain-related anxiety reduction in the outcome of multidisciplinary treatment for chronic low back pain: Preliminary results. J Occup Rehabil 1998; 8: 179–189.Google Scholar
  18. 18.
    Vlaeyen JWS, Seelen HAM, Peters M, et al. Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: An experimental investigation. Pain 1999; 82: 297–304.Google Scholar
  19. 19.
    Crombez G, Vlaeyen JWS, Heuts PHTG, Lysens R. Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain 1999; 80: 329–339.Google Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    Lackner JM, Carosella AM, Feuerstein M. Pain expectancies, pain, and functional self-efficacy expectancies as determinants of disability in patients with chronic low-back disorders. J Consult Clin Psychol 1996; 64: 212–220.Google Scholar
  22. 22.
    Asmundson GJG, Kuperos JL, Norton GR. Do patients with chronic pain selectively attend to pain-related information? Preliminary evidence for the mediating role of fear. Pain 1997; 72: 27–32.Google Scholar
  23. 23.
    Eccleston C, Crombez G, Aldrich S, Stannard C. Attention and somatic awareness in chronic pain. Pain 1997; 72: 209–215.Google Scholar
  24. 24.
    Crombez G, Eccleston C, Baeyens F, Eelen P. Attentional disruption is enhanced by threat of pain. Behav Res Ther 1998; 36: 195–204.Google Scholar
  25. 25.
    Crombez G, Eccleston C, Baeyens F, Eelen P. When somatic information threatens, catastrophic thinking enhances attentional interference. Pain 1998; 75: 187–198.Google Scholar
  26. 26.
    McCracken LM, Gross RT. Does anxiety affect coping with pain? Clin J Pain 1993; 9: 253–259.Google Scholar
  27. 27.
    Clark ME, Kori SH, Brockel J. Kinesiophobia and chronic pain: Psychometric characteristics and factor analysis of the Tampa Scale. Am Pain Soc Abst 1996; 15: 77.Google Scholar
  28. 28.
    Bonica JJ. Definitions and taxonomy of pain. In: Bonica JJ, ed. The Management of Pain, Vol. 1, 2nd Ed. Philadelphia: Lea and Febiger, 1990, pp. 18–27.Google Scholar
  29. 29.
    Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975; 1: 277–299.Google Scholar
  30. 30.
    Radloff L. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.Google Scholar
  31. 31.
    Berkman LF, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 1986; 124: 372–388.Google Scholar
  32. 32.
    Geisser ME, Roth RS, Bachman JE, Eckert, TA. The relationship between symptoms of post-traumatic stress disorder and affective disturbance, pain and disability among patients with accident and non-accident related pain. Pain 1996; 66: 207–214.Google Scholar
  33. 33.
    Turk DC. Okifuji A. Detecting depression in chronic pain patients: Adequacy of self-reports. Behav Res Ther 1994; 32: 9–16.Google Scholar
  34. 34.
    Curtis L, Mayer TG, Gatchel RJ. Physical progress and residual impairment quantification after functional restoration. Part III: Isokinetic and isoinertial lifting capacity. Spine 1994; 19(4): 401–405.Google Scholar
  35. 35.
    Mayer T, Barnes D, Kishino N et al. Progressive Isoinertial Lifting Evaluation I. A standardized protocol and normative data base. Spine 1988; 13: 993–997.Google Scholar
  36. 36.
    Mayer T, Barnes D, Nichols Get al. Progressive Isoinertial Lifting Evaluation II.Acomparison with isokinetic lifting in a disabled chronic low-back pain industrial population. Spine 1988; 13: 998–1002.Google Scholar
  37. 37.
    Borg G. Perceived exertion: A note on “history” and methods. Med Sci Sports 1973; 5: 90–93.Google Scholar
  38. 38.
    American College of Sports Medicine. Guidelines for Exercise Testing and Prescription, 3rd Ed. Philadelphia PA: Lea & Febiger, 1986.Google Scholar
  39. 39.
    Golding LA, Myers CR, Sinning WE, eds. The Y's way to physical fitness. Champaign, IL: Human Kinetics Publishers, 1989, pp. 88–98.Google Scholar
  40. 40.
    Fredrickson BE, Trief PM, VanBeveren P, Yuan HA, Baum G. Rehabilitation of the patient with chronic back pain. Spine 1988; 13: 351–353.Google Scholar
  41. 41.
    Kleinke CL, Spangler AS Jr. Predicting treatment outcome of chronic back pain patients in a multidisciplinary pain clinic: Methodological issues and treatment implications. Pain 1988; 33: 41–48.Google Scholar
  42. 42.
    Smith JK, Crisler JR. Variables associated with the vocational rehabilitation outcome of chronic low back pain individuals. J Appl Rehab Counsel 1985; 16: 22–24.Google Scholar
  43. 43.
    Weighill VE, Buglass D. An updated review of compensation neurosis. Pain Manag 1989; 2: 100–105.Google Scholar
  44. 44.
    Naliboff BD, Cohen MJ, Schandler SL, Heinrich, RL. Signal detection and threshold measures for chronic back pain patients, chronic illness patients, and cohort controls to radiant heat stimuli. J Abnorm Psychol 1981; 3: 271–274.Google Scholar
  45. 45.
    Jain GL, Pasricha JS, Guha SK. An attempt to reduce the loss of pain and touch sensations in leprosy patients. Indian J Leprosy 1986; 58: 225–232.Google Scholar
  46. 46.
    Abenhaim L, Rossignol M, Valat J-P, Nordin M, et al. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 2000; 25: 1S–33S.Google Scholar
  47. 47.
    Lackner JM, Carosella, AM. The relative influence of perceived pain control, anxiety, and functional self efficacy on spinal function among patients with chronic low back pain. Spine 1999; 24: 2254–2261.Google Scholar
  48. 48.
    Papciak AS, Feuerstein M. Psychological factors affecting isokinetic trunk strength testing in patients with work-related chronic low back pain. J Occup Rehabil 1991; 2: 95–104.Google Scholar
  49. 49.
    Robinson ME, O'Conner PD, MacMillan M, Shirley FR, Greene AF, Geisser ME, Fuller AK. Physical and psychosocial correlates of test-retest isometric torque variability in patients with chronic low back pain. J Occup Rehabil 1992; 2: 11–18.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Michael E. Geisser
    • 1
  • Andrew J. Haig
    • 2
  • Mary E. Theisen
    • 3
  1. 1.Department of Physical Medical Medicine and RehabilitationUniversity of Michigan Health System, The Spine ProgramAnn Arbor
  2. 2.Department of Physical Medical Medicine and Rehabilitation, Department of SurgeryUniversity of Michigan Health System, The Spine ProgramAnn Arbor
  3. 3.Department of Physical Medical Medicine and RehabilitationUniversity of Michigan Health System, The Spine ProgramAnn Arbor

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