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Factors associated with fear-avoidance beliefs about low back pain

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Low back pain (LBP) is a common major health problem. Fear-avoidance beliefs are thought to be an important risk factor for chronic LBP. This study investigated factors associated with the Fear-Avoidance Beliefs Questionnaire (FABQ) scores of Japanese adults who experienced LBP. We focused on the association of FABQ scores with medical advice to rest and the experience of seeing family members and/or significant others with disabling LBP.

Methods

In February 2011, 1,063,083 adults aged 20–79 years who had registered as internet-based research volunteers were randomly selected and invited to participate in a questionnaire survey. The data from 52,650 respondents who had experienced LBP were analyzed. Multiple linear regression analysis was used to examine the association between FABQ physical activity scores and the advice for respondents with LBP to rest, the experience of seeing others with disabling LBP, and other personal and LBP factors.

Results

After controlling for age, sex, and lifetime and current LBP disability grades, the experience of seeing others with disabling LBP (regression coefficient β = 0.94), rest advice (β = 0.91), history of chronic LBP (β = 0.78), radiating pain below the knee (β = 0.44), and workers’ compensation (β = 0.51) were associated with higher FABQ physical activity scores. Conversely, regular exercise (β = −0.89) and LBP attributed to sports (β = −0.76) were associated with lower FABQ physical activity scores.

Conclusion

The association between rest advice and higher fear-avoidance beliefs supports the recent treatment guidelines that emphasize continuation of daily activities.

Study design: cross-sectional study.

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References

  1. Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA, American Society of Interventional Pain Physicians. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12:E35–70.

    PubMed  Google Scholar 

  2. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8:8–20.

    Article  PubMed  Google Scholar 

  3. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443–54.

    Article  PubMed  CAS  Google Scholar 

  4. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62:233–40.

    Article  PubMed  Google Scholar 

  5. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manip Physiol Ther. 2004;27:238–44.

    Article  Google Scholar 

  6. Schmidt CO, Raspe H, Pfingsten M, Hasenbring M, Basler HD, Eich W, Kohlmann T. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976). 2007;32:2005–11.

    Article  Google Scholar 

  7. Becker A, Held H, Redaelli M, Strauch K, Chenot JF, Leonhardt C, Keller S, Baum E, Pfingsten M, Hildebrandt J, Basler HD, Kochen MM, Donner-Banzhoff N. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine (Phila Pa 1976). 2010;35:1714–20.

    Article  Google Scholar 

  8. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified primary care management for low back pain with current best practice (STarT back): a randomised controlled trial. Lancet. 2011;378:1560–71.

    Article  PubMed  Google Scholar 

  9. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002;27:E109–20.

    Article  Google Scholar 

  10. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.

    Article  PubMed  CAS  Google Scholar 

  11. Hilfiker R, Bachmann LM, Heitz CA, Lorenz T, Joronen H, Klipstein A. Value of predictive instruments to determine persisting restriction of function in patients with subacute non-specific low back pain. Systematic review. Eur Spine J. 2007;16:1755–75.

    Article  PubMed  Google Scholar 

  12. Crombez G, Vlaeyen JW, Heuts PH, 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;80:329–39.

    Article  PubMed  CAS  Google Scholar 

  13. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–68.

    Article  PubMed  CAS  Google Scholar 

  14. Jensen JN, Albertsen K, Borg V, Nabe-Nielsen K. The predictive effect of fear-avoidance beliefs on low back pain among newly qualified health care workers with and without previous low back pain: a prospective cohort study. BMC Musculoskelet Disord. 2009;10:117 (Available from: BioMed Central Ltd. Accessed October 1, 2011).

    Article  PubMed  Google Scholar 

  15. Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, Troup JD, Rose MJ. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976). 1995;20:478–84.

    Article  CAS  Google Scholar 

  16. Pincus T, Smeets RJ, Simmonds MJ, Sullivan MJ. The fear avoidance model disentangled: improving the clinical utility of the fear avoidance model. Clin J Pain. 2010;26:739–46.

    Article  PubMed  Google Scholar 

  17. Poiraudeau S, Rannou F, Baron G, Le Henanff A, Coudeyre E, Rozenberg S, Huas D, Martineau C, Jolivet-Landreau I, Garcia-Mace J, Revel M, Ravaud P. Fear-avoidance beliefs about back pain in patients with subacute low back pain. Pain. 2006;124:305–11.

    Article  PubMed  CAS  Google Scholar 

  18. Coudeyre E, Tubach F, Rannou F, Baron G, Coriat F, Brin S, Revel M, Poiraudeau S. Fear-avoidance beliefs about back pain in patients with acute LBP. Clin J Pain. 2007;23:720–5.

    Article  PubMed  Google Scholar 

  19. Buchbinder R, Jolley D, Wyatt M. Population based intervention to change back pain beliefs and disability: three part evaluation. BMJ. 2001;322:1516–20.

    Article  PubMed  CAS  Google Scholar 

  20. Coudeyre E, Rannou F, Tubach F, Baron G, Coriat F, Brin S, Revel M, Poiraudeau S. General practitioners’ fear-avoidance beliefs influence their management of patients with low back pain. Pain. 2006;124:330–7.

    Article  PubMed  Google Scholar 

  21. Osborn J, Derbyshire SW. Pain sensation evoked by observing injury in others. Pain. 2010;148:268–74.

    Article  PubMed  Google Scholar 

  22. Comprehensive survey of living conditions. http://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa10/3-1.html (2010). Accessed 9 Sept 2011 (in Japanese).

  23. National Health and Nutrition Survey. http://www.mhlw.go.jp/stf/houdou/2r9852000000xtwq.html (2009). Accessed 11 Oct 2011 (in Japanese).

  24. Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine (Phila Pa 1976). 2008;33:95–103.

    Article  Google Scholar 

  25. Matshudaira K, Inuzuka I, Kikuchi N, Isomura T. Development of the Japanese version of the Fear-Avoidance Beliefs Questionnaire (FABQ-J); translation and linguistic validation. Orthop Surg. 2011;62:1301–6.

    Google Scholar 

  26. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075–94.

    Article  PubMed  Google Scholar 

  27. Nachemson AL, Jonsson E. Neck and back pain: the scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 68.

    Google Scholar 

  28. Leavitt F. The role of psychological disturbance in extending disability time among compensable back injured industrial workers. J Psychosom Res. 1990;34:447–53.

    Article  PubMed  CAS  Google Scholar 

  29. Population census and labour force survey. http://www.stat.go.jp/data/index.htm (2007). Accessed 4 Oct 2011 (in Japanese).

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Acknowledgments

This study was supported by the dissemination project on the 13 fields of occupational injuries and illness of the Japan Labor Health and Welfare Organization.

Conflicts of interest

None declared.

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Authors and Affiliations

  1. Clinical Research Center for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan

    Tomoko Fujii & Ko Matsudaira

  2. Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroyuki Oka

Authors
  1. Tomoko Fujii
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  2. Ko Matsudaira
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  3. Hiroyuki Oka
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Corresponding author

Correspondence to Tomoko Fujii.

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Fujii, T., Matsudaira, K. & Oka, H. Factors associated with fear-avoidance beliefs about low back pain. J Orthop Sci 18, 909–915 (2013). https://doi.org/10.1007/s00776-013-0448-4

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  • DOI: https://doi.org/10.1007/s00776-013-0448-4

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