Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population

Pain. 2002 Oct;99(3):485-491. doi: 10.1016/S0304-3959(02)00265-8.


Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain. The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL). The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living / psychology*
  • Adult
  • Avoidance Learning*
  • Back Pain / epidemiology
  • Back Pain / psychology*
  • Cognition Disorders / etiology
  • Cognition Disorders / psychology
  • Confidence Intervals
  • Cross-Sectional Studies
  • Fear / psychology*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Psychological*
  • Odds Ratio
  • Risk Factors
  • Statistics, Nonparametric