Elsevier

The Spine Journal

Volume 14, Issue 11, 1 November 2014, Pages 2679-2681
The Spine Journal

Commentary
Current evidence on catastrophizing and fear avoidance beliefs in low back pain patients

https://doi.org/10.1016/j.spinee.2014.08.454Get rights and content

Commentary on

Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J 2014;14:2658–78 (in this issue).

Section snippets

Little Albert

Fear as a phobic stimulus may be traced back to the classic study published in 1920 by the psychologists John B. Watson and Rosaline Rayner at John Hopkins University [6]. In their experiment with little Albert, aged 9 months, a normally pleasant stimulus was conditioned or learned to be fearful. This study that would have been considered unethical today, provided evidence of classical conditioning in humans. At baseline, the emotionally stable child showed no fear of the white rat, but by

High catastrophizers experienced worse outcome

In the present systematic review, 89% of the records screened for inclusion were excluded. This suggests that results are prone to selection bias, but the authors have described the prespecified inclusion criteria in detail and exclusions seem justified. Twelve of the 16 included studies evaluated self-reported outcomes. Most of them found that catastrophizing was associated with pain and disability at follow-up. Five of six studies that applied cutoff values for the total score found that

High FAB scores are associated with worse outcome

The second systematic review evaluated the influence of FABs on work-related outcome, pain, and disability. Inclusion was limited to randomized controlled trials that investigated nonoperative treatment efficacy. Of 646 records, 78 studies were carefully evaluated, 12 high-quality studies and 5 low-quality studies were included. The authors concluded that in patients with low back pain for less than 6 months there was high-quality evidence that FAB (high scores) was associated with more pain

The educational aspect

The FAM may have focused too much on the psychological aspect of fear (like negative affect, catastrophizing), whereas other educational aspects may be equally important. Previous studies have reported that specialists dealing with low back pain have high FAB [26], [27]. These health-care providers are likely to recommend their patients to restrict physical activity that may negatively influence outcome [26], [27], [28]. From this perspective, modifying treatment strategies should start with

References (30)

  • J.I. Brox et al.

    Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study

    Pain

    (2006)
  • A. Froholdt et al.

    No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises

    Spine J

    (2011)
  • M. Leeuw et al.

    Exposure in vivo versus operant graded activity in chronic low back pain patients: esults of a randomized controlled trial

    Pain

    (2008)
  • J. Rainville et al.

    Fear-avoidance beliefs and pain avoidance in low back pain: translating research into clinical practice

    Spine J

    (2011)
  • J. Domenech et al.

    Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial

    Pain

    (2011)

    • FDA device/drug status: Not applicable.

    Author disclosures: JIB: Nothing to disclose.

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