Extent and nature of anxiety experienced during physical examination of chronic low back pain

There is strong evidence to suggest that anxiety is a common problem for ma ny chronic pain patients and can exacerbate a patient's pain condition. Not withstanding, there is little information about the extent and nature of an xiety experienced during physical examination of pain, or the primary facto rs associated with anxiety in this context. In the present study, 45 chroni c low back pain patients completed a questionnaire battery at the time of i ntake to an interdisciplinary treatment program. After approximately four w eeks on program, patients underwent a routine standardized physiotherapy re view of their condition following which they completed a second questionnai re battery. The examination was videotaped and coded for pain behavior. Phy siotherapists provided objective scoring of non-organic signs and physical impairment. Results suggested that participants experienced substantial anx iety at the point of examination with scores on the Beck Anxiety Inventory (M = 30.47, S.D. = 6.96) comparable to scores that have been found with DSM -IV panic disorder patients. Regression analyses revealed that catastrophic cognitions, behavioral displays of pain and somatic sensations measured du ring examination uniquely predicted anxiety experienced during examination. Demographic, injury-related, personality, and patient-practitioner variabl es did not significantly contribute to explaining examination anxiety. Find ings support cognitive-behavioral formulations of anxiety and strongly sugg est that anxiety may complicate the assessment process, Implications for th e assessment and treatment of pain are presented along with future research directions. (C) 1999 Elsevier Science Ltd. All rights reserved.