Pain-related fear is more disabling than pain itself: evidence on the roleof pain-related fear in chronic back pain disability

There is growing evidence for the idea that in back pain patients, pain-rel ated fear (fear of pain/physical activity/(re)injury) may be more disabling than pain itself. A number of questionnaires have been developed to quanti fy pain-related fears, including the Fear-Avoidance Beliefs Questionnaire ( FABQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Anxiety Sympto ms Scale (PASS). A total of 104 patients, presenting to a rehabilitation ce nter or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aimed at (1) replicating that pain-related fe ar is more disabling than pain itself(2) investigating the association betw een pain-related fear and poor behavioral performance and (3) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs (e.g. pain catastrophizing). All three studies showe d similar results. Highest correlations were found among the pain-related f ear measures and measures of self-reported disability and behavioral perfor mance. Even when controlling for sociodemographics, multiple regression ana lyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance. The PA SS appeared more strongly associated with pain catastrophizing and negative affect, and was less predictive of pain disability and behavioral performa nce. Implications for chronic back pain assessment, prevention and treatmen t are discussed. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.