Fear of pain can disable a patient in many ways. Previous literature has reported that the fear of pain induces avoidance behavior (which lends to low physical activity), interferes with cognitive functioning, and that long-standing avoidance and disability eventually affects physiological systems. The authors of this study, performed three separate studies to investigate pain related fear. The first assessed if pain-related fear is more disabling than pain itself; the second looked to see if there is an association between fear and poor work performance; and the third compared pain related fear measures and general mental health to assess which was a better predictor of disability and performance.
The first inquiry consisted of 35 chronic low back pain patients. The participants self-reported their disability by replying to questionnaires that evaluated current pain intensity, pan-related fear, disability and general negative affect. The findings revealed that disability significantly correlated to pain-related fear scores, but not to pain intensity or negative affect scores—pain-related fear was a better predictor of disability than the other two.
In investigating the role of pain severity, pain related fear, pain anticipation, and negative affect's role in predicting performance the authors found, surprisingly, that none of the pain-related fear measures correlated to the patients' level of pain expectancy. What emerged as a predictor of decreased performance was the expectation of pain, not the actual pain experienced.
With 31 chronic low back pain patients the authors finally examined pain severity, pain-related fear, and negative affect scores to predict self-reported disability and behavioral performance. The authors found that if patients' pain occurred suddenly the pain related fear was higher; if patients' pain developed gradually the disability scores were higher. Also pain-related fear was more predictive of physical performance than the current pain intensity or increase. And as other studies have implied, the low back pain patients' physical performance was significantly influenced by the presence of pain radiating in at least one leg.
These findings indicate pain-related fear is a solid predictor of a patient's performance and self-perceived disability. Since it plays such a major role, the authors attempt to answer what, exactly, these patients fear. They offer three possibilities:
As well, the authors than provide a plan to handle chronic low back pain patients, or any patients with high levels of pain-related fear:
The authors conclude that since fear of pain gauged in as a powerful psychological challenge for chronic disability additional studies are needed to understand all the mechanisms that lead to chronic pain and disability.
Crombez G, Vlaeyen JWS, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 1999;80:329-339.