Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factors in che transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whet her they are associated with the inception of an episode of neck or back pa in. The aim of this study was to evaluate prospectively the effects of fear -avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported n o spinal pain during the past year. At the pretest a battery of questionnai res was administered to assess beliefs about pain and activity and it featu red the Pain Catastrophizing Scale and a modified version of the Fear-Avoid ance Beliefs Questionnaire. One year later outcome was evaluated by self-re ports of the occurrence of a pain episode as well as a self-administered ph ysical function test. The results showed that scores on both fear-avoidance and catastrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the me dian on fear-avoidance beliefs at the pretest had twice the risk of sufferi ng an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, incre asing the risk of pain or lowered function by 1.5, but with confidence inte rvals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early point in the development of pain and associ ated activity problems in people with back pain. Theoretically, our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastro phizing and particularly fear-avoidance beliefs are important in the develo pment of a pain problem and might be of use in screening procedures.