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Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-9429-9012
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-5359-0452
2006 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 22, no 2, p. 160-166Article in journal (Refereed) Published
Abstract [en]

Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.

Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.

Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters medium pain-related fear and low risk, the majority of those classified in the clusters pain-related fear, pain-related fear + depressed mood, and depressed mood reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the pain-related fear + depressed mood group and 42% in the depressed mood group reported >10 health care visits).

Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2006. Vol. 22, no 2, p. 160-166
National Category
Social Sciences Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-2816PubMedID: 16428950OAI: oai:DiVA.org:oru-2816DiVA, id: diva2:134641
Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2018-02-20Bibliographically approved
In thesis
1. Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
Open this publication in new window or tab >>Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Betydelsen av rädsla och undvikande i utvecklingen av ett långvarigt smärtproblem : implikationer för sekundär prevention
Abstract [en]

This dissertation focused on the role of fear and avoidance in the development of a persistent back pain problem. The first aim of this dissertation was to study when and how cognitive, affective and behavioral factors influence one another in the development of persistent pain and disability. The moderating role of pain duration on the relationship between psychological risk factors and dysfunction was studied, as well as the interrelationships between psychological risk factors within individuals.

The results suggest that pain duration may moderate the relationship between some of the psychological risk factors and function. In study two, depression and function were interrelated independent of stages of chronicity while the strength of the relationship between fear of movement and function increased across the stages. Further, the results suggest that there may be individual variability in the importance of psychological risk factors and in how these factors are interrelated within individuals. In study one and three profiles of psychological functioning emerged that were characterized by pain-related fear with and without depressed mood, by depressed mood only, and by low pain-related fear and no depressed mood. These profiles were meaningfully related to future disability.

The second aim of this dissertation was to test a new treatment that is designed to match patients with high levels of fear and avoidance. The results of study four show that this exposure treatment can produce significant decreases in fear and increases in function.

The results of the studies in this dissertation suggest that we need to assign a key role to psychological processes such as pain-related fear, depressed mood, and avoidance in our efforts to understand the development of persistent back pain disability. The results highlight that there may be several roads towards a persistent back pain problem and that the relationship between psychological factors and disability is not static but appears to change as a function of pain duration. This suggests that we need to know more about the process of development of persistent back pain disability and that future research should incorporate the role of time, as well as take into consideration that there may be individual variability in the importance of factors and their interactions. Lastly, the results suggest that secondary prevention of persistent back pain disability could be enhanced by addressing psychological processes at a much earlier time point than is currently practiced and by customizing interventions to the characteristics of the individual patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2005. p. 71
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 5
Keywords
Psychology, pain-related fear, fear-avoidance model, back pain, disability, development, exposure, Psykologi
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-110 (URN)91-7668-433-4 (ISBN)
Public defence
2005-05-20, Aulan, B-huset, Universitetssjukhuset, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-10-18Bibliographically approved

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Boersma, KatjaLinton, Steven J.

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