Spine. Volume 36(19), 01 September 2011, p 1547–1553

The Impact of Fear-Avoidance Model Variables on Disability in Patients With Specific or Nonspecific Chronic Low Back Pain

Lundberg, Mari RPT, PhD; Frennered, Karin MD, PhD; Hägg, Olle MD, PhD; Styf, Jorma MD, PhD
Author InformationFrom the Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. © 2011 Lippincott Williams & Wilkins, Inc.

Study Design. A prospective cross-sectional design.

Objective. The objectives were to describe the occurrence and to investigate the association of the fear-avoidance model variables (pain intensity, kinesiophobia, depression, and disability) in patients with specific or nonspecific chronic low back pain (CLBP).

Summary of Background Data. Affective factors, particularly fear, have proven to be central in the explanation and understanding of chronic pain. The fear-avoidance model has shown that fearful patients with CLBP are at risk of becoming trapped in a vicious cycle of pain, fear, disability, and depressive symptoms. Little is known about the relationship between these factors in patients subgrouped as specific or nonspecific CLBP.

Methods. All 147 patients (81 women and 66 men) were examined by an orthopedic surgeon and diagnosed as either specific or nonspecific CLBP on the basis of that examination. Hierarchical multiple regression analysis was used to assess the ability of three independent variables (back pain intensity, VAS; kinesiophobia, TSK; depressed mood, Zung) to predict levels of disability after controlling for the influence of age and sex.

Results. Both groups (specific and nonspecific CLBP) presented elevated values on the fear-avoidance model variables. All the independent fear-avoidance variables contributed in a statistically significant manner to predict disability in patients with specific CLBP, 67.0%, F (5, 59) = 24.46, P < 0.000. In patients with nonspecific CLBP, all variables except kinesiophobia predicted disability in a statistically significant manner, 63.0%, F (5, 59) = 22.64, P < 0.000.

Conclusion. We conclude that persistent musculoskeletal pain affects the individual in a similar manner, regardless of the cause of the pain. In clinical terms, this means that pain must be analyzed and treated as a parallel process to searching for the cause of the pain.