Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 3 Issue 12

Addressing Fear Avoidance and Self-efficacy Beliefs to Reduce Disability in Patients with Non-specific Low Back Pain: From Theory to Application

George A Koumantakis1,2*

1Assistant Professor, Department of Physiotherapy, University of West Attica (UNIWA), Athens, Greece
2Director, Laboratory of Advanced Physiotherapy (LAdPhys), Department of Physiotherapy, University of West Attica (UNIWA), Athens, Greece

*Corresponding Author: George A Koumantakis, Laboratory of Advanced Physiotherapy (LAdPhys), Department of Physiotherapy, University of West Attica (UNIWA), Athens, Greece.

Received: October 27, 2020; Published: November 18, 2020

×

Abstract

  A considerable proportion of patients with non-specific low back pain (nsLBP) report continued symptoms for an extended period of time. In many cases no structural lesion can be identified. Biopsychosocial models attempt to identify the contribution of several psychosocial factors contributing to the development and maintenance of chronic disability in these patients. The fear avoidance model postulates that patients may respond to pain with an avoidance behavior, reducing the level of their activities, resulting in a vicious cycle of prolonged disability, disuse and further pain experience. The aim of this mini-review is to present some of the most relevant evidence on the interrelationship of fear avoidance as well as self-efficacy beliefs with disability in patients with nsLBP and physical therapy-related methods targeting disability improvement through fear amelioration techniques. It is concluded that fear is a contributing factor leading to greater levels of disability in individuals suffering an acute episode and is also influencing patient disability further in the subacute and chronic stage of symptoms, also affecting LBP recurrence rate. Results of some studies indicate that there may be additional cognitive factors, like self-efficacy, influencing the outcome of therapy, mainly for those experiencing acute back pain symptoms. Further investigations should take into account and examine the joint contribution of such psychological factors in order to implement effective and targeted therapy interventions for patients with back pain.

Keywords: Cognitive Factors; Psychosocial; Chronicity; Physical Therapy; Graded Exposure; Pain Neuroscience Education

×

References

  1. Sieben JM., et al. “Pain-related fear in acute low back pain: the first two weeks of a new episode”. European Journal of Pain3 (2002): 229-237.
  2. Waddell, G. “The Back Pain Revolution”. 2nd ed. Edinburgh: Churchill Livingstone (2004).
  3. Croft PR., et al. “Outcome of low back pain in general practice: a prospective study”. BMJ 7141 (1998): 1356-1359.
  4. Watson PJ., et al. “Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow-up study of the working population of Jersey”. British Journal of Rheumatology1 (1998): 82-86.
  5. Maniadakis N and A Gray. “The economic burden of back pain in the UK”. Pain1 (2000): 95-103.
  6. Dagenais S., et al. “A systematic review of low back pain cost of illness studies in the United States and internationally”. Spine Journal1 (2008): 8-20.
  7. Andronis L., et al. “Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review”. Applied Health Economics and Health Policy (2016).
  8. Pope MH., et al. “Spine ergonomics”. Annual Review of Biomedical Engineering 4 (2002): 49-68.
  9. Koumantakis GA. “Muscle activity and back pain”. in Topical Issues in Pain 5, L. Gifford, Editor. CNS Press Ltd.: Kestrel, UK (2006): 341-377.
  10. Tagliaferri SD., et al. “Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective”. Pain Practice2 (2020): 211-225.
  11. Rainville J., et al. “Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice”. Spine Journal9 (2011): 895-903.
  12. Crombez G., et al. “Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability”. Pain 80 (1999): 329-339.
  13. Asmundson GJ., et al. “Beyond pain: the role of fear and avoidance in chronicity”. Clinical Psychology Review1 (1999): 97-119.
  14. Bunzli, S., et al. “Making Sense of Low Back Pain and Pain-Related Fear”. Journal of Orthopaedic and Sports Physical Therapy9 (2017): 628-636.
  15. Vlaeyen JW and G Crombez. “Fear of movement/ (re)injury, avoidance and pain disability in chronic low back pain patients”. Manual Therapy4 (1999): 187-195.
  16. Swinkels-Meewisse IE., et al. “Fear of movement/ (re)injury predicting chronic disabling low back pain: a prospective inception cohort study”. Spine (Phila Pa 1976) 6 (2006): 658-664.
  17. Vlaeyen JW and SJ Linton. “Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art”. Pain3 (2000): 317-332.
  18. Vlaeyen JW., et al. “Fear of movement/ (re)injury in chronic low back pain and its relation to behavioral performance”. Pain3 (1995): 363-372.
  19. Lethem J., et al. “Outline of a Fear-Avoidance Model of exaggerated pain perception—I”. Behaviour Research and Therapy 4 (1983): 401-418.
  20. Vlaeyen JW., et al. “The role of fear of movement/ (re)injury in pain disability”. Journal of Occupational Rehabilitation4 (1995): 235-252.
  21. Melzack R. “Pain and the neuromatrix in the brain”. Journal of Dental Education 12 (2001): 1378-1382.
  22. Melzack R. “From the gate to the neuromatrix”. Pain 6 (1999): S121-126.
  23. Meier ML., et al. “The impact of pain-related fear on neural pathways of pain modulation in chronic low back pain”. Pain Reports3 (2017): e601-e601.
  24. Barke A., et al. “Neural Correlates Differ in High and Low Fear-Avoidant Chronic Low Back Pain Patients When Imagining Back-Straining Movements”. Journal of Pain8 (2016): 930-943.
  25. Wertli MM., et al. “Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review”. Spine Journal11 (2014): 2658-2678.
  26. Crombez G., et al. “Fear-avoidance model of chronic pain: the next generation”. Clinical Journal of Pain6 (2012): 475-483.
  27. McCracken LM and RT Gross. “Does anxiety affect coping with chronic pain?”. Clinical Journal of Pain4 (1993): 253-259.
  28. Al-Obaidi SM., et al. “The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain”. Spine (Phila Pa 1976) 9 (2000): 1126-1131.
  29. Zale EL., et al. “The relation between pain-related fear and disability: a meta-analysis”. The Journal of Pain: Official Journal of the American Pain Society10 (2013): 1019-1030.
  30. Lee H., et al. “How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain”. Pain6 (2015): 988-997.
  31. George SZ., et al. “The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial”. Spine (Phila Pa 1976) 23 (2003): 2551-2560.
  32. Klenerman L., et al. “The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting’. Spine (Phila Pa 1976) 4 (1995): 478-484.
  33. Waddell G., et al. “A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability”. Pain2 (1993): 157-168.
  34. Fritz JM and SZ George. “Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs”. Physical Therapy10 (2002): 973-983.
  35. Swinkels-Meewisse IE., et al. “Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain”. Clinical Journal of Pain1 (2006): 45-54.
  36. Swinkels-Meewisse IE., et al. “Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability”. Pain 120 (2006): 36-43.
  37. Sieben JM., et al. “A longitudinal study on the predictive validity of the fear-avoidance model in low back pain”. Pain 117 (2005): 162-170.
  38. Grotle M., et al. “Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain”. Pain4 (2004): 343-352.
  39. Boersma K and SJ Linton. “How does persistent pain develop? An analysis of the relationship between psychological variables, pain and function across stages of chronicity”. Behaviour Research and Therapy 11 (2005): 1495-1507.
  40. Thomas JS and CR France. “The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain”. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society1 (2008): 97-103.
  41. Linton SJ., et al. “Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study”. Psychology Health6 (2000): 1051-1059.
  42. Picavet HS., et al. “Pain catastrophizing and kinesiophobia: predictors of chronic low back pain”. American Journal of Epidemiology11 (2002): 1028-1034.
  43. Gheldof EL., et al. “Pain-related fear predicts disability, but not pain severity: a path analytic approach of the fear-avoidance model”. European Journal of Pain8 (2010): 870.e1-9.
  44. Costa Lda C., et al. “Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain”. European Journal of Pain2 (2011): 213-219.
  45. Ayre M and GA Tyson. “The role of self-efficacy and fear-avoidance beliefs in the prediction of disability”. Australian Psychologist3 (2001): 250-253.
  46. Denison E., et al. “Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care”. Pain3 (2004): 245-252.
  47. Foster NE., et al. “Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care”. Pain3 (2010): 398-406.
  48. Woby SR., et al. “Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients”. European Journal of Pain7 (2007): 711-718.
  49. Woby SR., et al. “Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes”. Physiotherapy2 (2008): 115-124.
  50. Fordham B., et al. “Explaining How Cognitive Behavioral Approaches Work for Low Back Pain: Mediation Analysis of the Back Skills Training Trial”. Spine (Phila Pa 1976) 17 (2017): E1031-e1039.
  51. Houben RM., et al. “Health care providers' orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity”. European Journal of Pain2 (2005): 173-183.
  52. Cowell I., et al. “Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: A qualitative study”. Musculoskeletal Science and Practice 38 (2018): 113-119.
  53. Holden J., et al. “Health coaching for low back pain: a systematic review of the literature”. International Journal of Clinical Practice8 (2014): 950-962.
  54. Ben-Ami N., et al. “Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial”. Journal of Orthopaedic and Sports Physical Therapy2 (2017): 57-66.
  55. Nijs J., et al. “In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain”. Clinical and Experimental Rheumatology 5 (2017): 108-115.
  56. Louw A., et al. “The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature”. Physiotherapy Theory and Practice5 (2016): 332-355.
  57. Moseley GL and DS Butler. “Fifteen Years of Explaining Pain: The Past, Present, and Future”. Journal of Pain 9 (2015): 807-813.
  58. Woods MP and GJ Asmundson. “Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial”. Pain3 (2008): 271-280.
  59. López-de-Uralde-Villanueva I., et al. “A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain”. Pain Medicine 1 (2016): 172-188.
  60. Jones GT., et al. “Predicting persistent disabling low back pain in general practice: a prospective cohort study”. British Journal of General Practice 526 (2006): 334-341.
  61. Koumantakis GA., et al. “Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain”. Physical Therapy3 (2005): 209-225.
  62. Lin CW., et al. “Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis”. Pain3 (2011): 607-613.
  63. Wand BM., et al. “Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise”. Spine (Phila Pa 1976) 21 (2005): 2350-2356.
  64. Bailly F., et al. “The impact of chronic low back pain is partly related to loss of social role: A qualitative study”. Joint Bone Spine6 (2015): 437-441.

 

×

Citation

Citation: George A Koumantakis. “Addressing Fear Avoidance and Self-efficacy Beliefs to Reduce Disability in Patients with Non-specific Low Back Pain: From Theory to Application".Acta Scientific Orthopaedics 3.12 (2020): 43-51.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is November 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US