Postural Stability in Osteoarthritis of the Knee and Hip: Analysis of Association With Pain Catastrophizing and Fear-Avoidance Beliefs

PM&R ◽  
2016 ◽  
Vol 8 (7) ◽  
pp. 618-628 ◽  
Author(s):  
Ángel Sánchez-Herán ◽  
Diego Agudo-Carmona ◽  
Raúl Ferrer-Peña ◽  
Ibai López-de-Uralde-Villanueva ◽  
Alfonso Gil-Martínez ◽  
...  
Keyword(s):  
Postural Stability ◽  
Pain Catastrophizing ◽  
Osteoarthritis Of The Knee ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs

Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Brittany L Sisco-Taylor ◽  
John S Magel ◽  
Molly McFadden ◽  
Tom Greene ◽  
Jincheng Shen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain ◽  
Early Physical Therapy

Abstract Objective The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. Subjects Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. Methods Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. Results Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. Conclusions In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing.

Pain-related fear, catastrophizing and pain in the recovery from a fracture

2010 ◽  
Vol 1 (1) ◽  
pp. 38-42 ◽  
Author(s):  
J. Linton Steven ◽  
Nina Buer ◽  
Lars Samuelsson ◽  
Karin Harms-Ringdahl
Keyword(s):  
Pain Catastrophizing ◽  
Recovery Process ◽  
Wrist Fracture ◽  
Full Recovery ◽  
Standardized Assessments ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Increased Risk ◽  
And Function

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.

scholarly journals Development and Validation of the Athlete Fear Avoidance Questionnaire

2015 ◽  
Vol 50 (6) ◽  
pp. 634-642 ◽  
Author(s):  
Geoffrey Dover ◽  
Vanessa Amar
Keyword(s):  
General Population ◽  
Concurrent Validity ◽  
Pain Perception ◽  
Pain Catastrophizing ◽  
Pain Catastrophizing Scale ◽  
Fear Avoidance ◽  
Cross Sectional ◽  
Fear Avoidance Beliefs ◽  
Varsity Athletes ◽  
Fear Avoidance Beliefs Questionnaire

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.

Convergent and known group validity of the STarT Back Tool in a Nigerian population with chronic low back pain

physioscience ◽  
2021 ◽  
Author(s):  
Chidozie Emmanuel Mbada ◽  
Joshua Oluwafunmibi Ojo ◽  
Opeyemi Ayodiipo Idowu ◽  
Taofik Oluwasegun Afolabi ◽  
Aanuoluwapo Deborah Afolabi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Disability ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Group Validity ◽  
Nigerian Population

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.

Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden

2014 ◽  
Vol 5 (3) ◽  
pp. 193-199 ◽  
Author(s):  
Johanna Thomtén ◽  
Andreas Karlsson
Keyword(s):  
Negative Affect ◽  
Sexual Satisfaction ◽  
Anxiety Sensitivity ◽  
Response Rate ◽  
Fungal Infections ◽  
Pain Catastrophizing ◽  
Strong Support ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Genital Pain

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.

scholarly journals Pain catastrophizing, kinesiophobia and fear-avoidance in non-specific work-related low-back pain as predictors of sickness absence

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242994
Author(s):  
Israel Macías-Toronjo ◽  
María Jesús Rojas-Ocaña ◽  
José Luis Sánchez-Ramos ◽  
E. Begoña García-Navarro
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sickness Absence ◽  
Pain Catastrophizing ◽  
Specific Work ◽  
Work Absence ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Work Related

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.

scholarly journals Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain

2021 ◽  
Vol 18 (16) ◽  
pp. 8848
Author(s):  
Norollah Javdaneh ◽  
Atle Hole Saeterbakken ◽  
Arash Shams ◽  
Amir Hossein Barati
Keyword(s):  
Neck Pain ◽  
Self Efficacy ◽  
Pain Catastrophizing ◽  
Chronic Neck Pain ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Pain Disability Index ◽  
Pain Disability ◽  
Therapeutic Exercises ◽  
Neuroscience Education

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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