Skip to main content
SpringerLink
Log in

The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Pain-related fear has been associated with avoidance behavior and increased risk for chronic low back pain; however, few studies have examined how pain-related fear relates specifically to motion of the spine following an acute episode of back pain. Thirty-six participants with a recent episode of low back pain were recruited from the general population using a combination of fliers and radio advertisements. To explore the natural recovery from low back pain we recruited individuals who were not seeking medical care. Participants performed a forward bending task at 3, 6, and 12 weeks following onset of low back pain. Three-dimensional joint motions of the spine and hip were recorded using an electromagnetic tracking device. Initial assessments of low back pain and pain-related fear were then correlated with joint excursions observed during each forward bending. Lumbar motion was inversely related to pain-related fear, but not low back pain, at all three testing sessions. In contrast, hip motion was inversely related to pain at all three testing sessions but was not related to fear. These findings suggest that pain-related fear results in avoidance behavior that specifically limits or restricts motion of the lumbar spine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Al-Obaidi SM, Nelson RM, Al-Awadhi S, Al-Shuwaie N (2000) The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain. Spine 25(9):1126–1131

    Article  PubMed  CAS  Google Scholar 

  2. Al-Obaidi SM, Al-Zoabi B, Al-Shuwaie N, Al-Zaabie N, Nelson RM. (2003) The influence of pain and pain-related fear and disability beliefs on walking velocity in chronic low back pain. Int J Rehabil Res 26(2):101–108

    Article  PubMed  Google Scholar 

  3. Asmundson GJ, Norton PJ, Vlaeyen JW (2004) Fear avoidance models of chronic pain: an overview. In: Asmundson GL, Vlaeyen JW, Crombez G (eds) Understanding and treating fear of pain. Oxford University Press, Oxford, pp 3–24

    Google Scholar 

  4. Buer N, Linton SJ (2002) Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population. Pain 99(3):485–491

    Article  PubMed  Google Scholar 

  5. Burns JW, Mullen JT, Higdon LJ, Wei JM, Lansky D (2000) Validity of the pain anxiety ymptoms scale (PASS): prediction of physical capacity variables. Pain 84(2–3):247–252

    Article  PubMed  CAS  Google Scholar 

  6. Crombez G, Vervaet L, Lysens R, Baeyens F, Eelen P (1998) Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behav Modif 22(1):62–77

    Article  PubMed  CAS  Google Scholar 

  7. Crombez G, Vlaeyen JW, Heuts PH, Lysens R (1999) Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 80(1–2):329–339

    Article  PubMed  CAS  Google Scholar 

  8. Crombez G, Eccleston C, Vlaeyen JW, Vansteenwegen D, Lysens R, Eelen P (2002) Exposure to physical movements in low back pain patients: restricted effects of generalization. Health Psychol 21(6):573–578

    Article  PubMed  Google Scholar 

  9. Esola MA, McClure PW, Fitzgerald GK, Siegler S (1996) Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Spine 21(1):71–78

    Article  PubMed  CAS  Google Scholar 

  10. Fritz JM, George SZ, Delitto A (2001) The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain 94(1):7–15

    Article  PubMed  CAS  Google Scholar 

  11. Fritz JM, George SZ (2002) Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Phys Ther 82(10):973–983

    PubMed  Google Scholar 

  12. Geisser ME, Roth RS, Theisen ME, Robinson ME, Riley JL III (2000) Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain. Clin J Pain 16(2):110–120

    Article  PubMed  CAS  Google Scholar 

  13. George SZ, Fritz JM, Erhard RE (2001) A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine 26(19):2139–2154

    Article  PubMed  CAS  Google Scholar 

  14. George SZ, Fritz JM, McNeil DW (2006) Fear-avoidance beliefs as measured by the fear-avoidance beliefs questionnaire: change in fear-avoidance beliefs questionnaire is predictive of change in self-report of disability and pain intensity for patients with acute low back pain. Clin J Pain 22(2):197–203

    Article  PubMed  Google Scholar 

  15. Grafton KV, Foster NE, Wright CC (2005) Test-retest reliability of the short-form McGill pain questionnaire: assessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis. Clin J Pain 21(1):73–82

    Article  PubMed  Google Scholar 

  16. Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, et al (1995) The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 20(4):478–484

    Article  PubMed  CAS  Google Scholar 

  17. Kori KS, Miller RP, Todd DD (1990) Kinesiophobia: a new view of chronic behavior. Pain Manage Jan/Feb:35–43

    Google Scholar 

  18. Lariviere C, Gagnon D, Loisel P (2000) The effect of load on the coordination of the trunk for subjects with and without chronic low back pain during flexion-extension and lateral bending tasks. Clin Biomech 15(6):407–416

    Article  CAS  Google Scholar 

  19. McCracken LM, Zayfert C, Gross RT (1992) The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain 50(1):67–73

    Article  PubMed  CAS  Google Scholar 

  20. McCracken LM, Gross RT, Aikens J, Carnrike CL Jr (1996) The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments. Behav Res Ther 34(11–12):927–933

    Article  PubMed  CAS  Google Scholar 

  21. Melzack R (1975) The McGill pain questionnaire: Major properties and scoring methods. Pain 1:277–299

    Article  PubMed  CAS  Google Scholar 

  22. Melzack R, Katz J (2001) The McGill pain questionnaire: appraisal and current status. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guilford, New York

    Google Scholar 

  23. Parks KA, Crichton KS, Goldford RJ, McGill SM (2003) A comparison of lumbar range of motion and functional ability scores in patients with low back pain: assessment for range of motion validity. Spine 28(4):380–384

    Article  PubMed  CAS  Google Scholar 

  24. Poitras S, Loisel P, Prince F, Lemaire J (2000) Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil 81(10):1394–1400

    Article  PubMed  CAS  Google Scholar 

  25. Porter JL, Wilkinson A (1997) Lumbar-hip flexion motion. A comparative study between asymptomatic and chronic low back pain in 18- to 36-year-old men. Spine 22(13):1508–1513 discussion 13–4

    Article  PubMed  CAS  Google Scholar 

  26. Roelofs J, McCracken L, Peters ML, Crombez G, van Breukelen G, Vlaeyen JW (2004) Psychometric evaluation of the pain anxiety symptoms scale (PASS) in chronic pain patients. J Behav Med 27(2):167–183

    Article  PubMed  Google Scholar 

  27. Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8(2):141–144

    Article  PubMed  CAS  Google Scholar 

  28. Roland M, Fairbank J (2000) The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25(24):3115–3124

    Article  PubMed  CAS  Google Scholar 

  29. Sahrmann SA (2002) Diagnosis and Treatment of Movement Impairment Syndromes. Saint Louis, Mosby

    Google Scholar 

  30. Sieben JM, Vlaeyen JW, Tuerlinckx S, Portegijs PJ (2002) Pain-related fear in acute low back pain: the first two weeks of a new episode. Eur J Pain 6(3):229–237

    Article  PubMed  Google Scholar 

  31. Simmonds MJ, Olson SL, Jones S, Hussein T, Lee CE, Novy D et al (1998) Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 23(22):2412–2421

    Article  PubMed  CAS  Google Scholar 

  32. Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA et al (2001) Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 17(1):52–64

    Article  PubMed  CAS  Google Scholar 

  33. Sullivan MJL, Bishop SR, Pivik J (1995) The pain catastrophizing scale: development and validation. Psychol Assess 7:524–532

    Article  Google Scholar 

  34. Swinkels-Meewisse IE, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA (2003) Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther 8(1):29–36

    Article  PubMed  CAS  Google Scholar 

  35. Swinkels-Meewisse IE, Roelofs J, Oostendorp RA, Verbeek AL, Vlaeyen JW (2006) Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain 120(1–2):36–43

    Article  PubMed  Google Scholar 

  36. Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR (1998) Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care. Spine 23(3):343–347

    Article  PubMed  CAS  Google Scholar 

  37. Thomas JS, France CR (2007) Pain-related fear is associated with avoidance of spinal motion during recovery from low back pain. Spine 32(16):E460–E466

    Article  PubMed  Google Scholar 

  38. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 62(3):363–372

    Article  PubMed  CAS  Google Scholar 

  39. Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85(3):317–332

    Article  PubMed  CAS  Google Scholar 

  40. Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G (2002) The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain 18(4):251–261

    Article  PubMed  Google Scholar 

  41. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A fear-avoidance beliefs questionnaire (FABQ) and the role of fear- avoidance beliefs in chronic low back pain and disability. Pain 52(2):157–168

    Article  PubMed  CAS  Google Scholar 

  42. Wong TK, Lee RY (2004) Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci 23(1):21–34

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by National Institutes of Health Grant grants RO1-HD045512.

Author information

Authors and Affiliations

  1. School of Physical Therapy, Ohio University, W277 Grover Center, Athens, OH, 45701, USA

    James S. Thomas

  2. Department of Psychology, Ohio University, Athens, OH, USA

    Christopher R. France

Authors
  1. James S. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher R. France
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James S. Thomas.

Additional information

The authors of the manuscript have no financial or other relationships that might lead to a conflict of interest, and the study was conducted in accordance with the current American Psychological Association guidelines for human research and was approved by the Ohio University Institutional Review Board.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomas, J.S., France, C.R. The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J 17, 97–103 (2008). https://doi.org/10.1007/s00586-007-0532-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-007-0532-6

Keywords

Search

Navigation