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Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain
Örebro University, School of Health and Medical Sciences. (Centre for Health and Medical Psychology, Örebro University)
Örebro University, School of Law, Psychology and Social Work. (Centre for Health and Medical Psychology, Örebro University)ORCID iD: 0000-0001-9429-9012
Centre for Clinical Research, Uppsala University, Central Hospital, Västerås.
Örebro University, School of Law, Psychology and Social Work. (Centre for Health and Medical Psychology, Örebro University)ORCID iD: 0000-0001-5359-0452
2011 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 27, no 7, 567-577 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.

Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.

Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.

Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011. Vol. 27, no 7, 567-577 p.
Keyword [en]
musculoskeletal pain, fear-avoidance beliefs, catastrophizing, emotional distress, function, sick leave
National Category
Family Medicine Psychology
Research subject
Family Medicine; Rehabilitation Medicine; Psychology
Identifiers
URN: urn:nbn:se:oru:diva-10064DOI: 10.1097/AJP.0b013e318219ab6cISI: 000293730800002PubMedID: 21540739Scopus ID: 2-s2.0-80051798113OAI: oai:DiVA.org:oru-10064DiVA: diva2:304419
Available from: 2010-03-18 Created: 2010-03-18 Last updated: 2017-02-08Bibliographically approved
In thesis
1. Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment
Open this publication in new window or tab >>Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care.

To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV).

Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 82 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 40
Keyword
musculoskeletal pain, biopsychosocial, multimodal, fear-avoidance, catastrophizing, distress, sick leave, function
National Category
Family Medicine Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine; Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10084 (URN)978-91-7668-716-1 (ISBN)
Public defence
2010-04-23, Aulan, ingång 21, 721 89, Centrallasarettet, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-03-19 Created: 2010-03-18 Last updated: 2011-04-26Bibliographically approved

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