Pain expectancy and work disability in patients with acute and chronic pain: a test of the fear avoidance hypothesis

J Pain. 2001 Jun;2(3):181-94. doi: 10.1054/jpai.2001.21591.


According to the fear avoidance model, prolonged disability among patients with chronic nonmalignant pain is due, in part, to an exaggerated fear of pain. At issue in the present study was an attempt to refine the fear-avoidance hypothesis by eliciting estimates of anticipated pain as well as anticipated injury. Along with scores on the Fear Avoidance Beliefs Questionnaire-Work (FABQ-W), a validated measure of fear avoidance, pain and injury expectancies were used as predictors of work disability in a hierarchical regression model. We also examined the possibility that fear avoidance might be confined to patients with chronic pain and thus fail to account for work impairment after the onset of acute injury or illness. Samples of patients with acute (N = 47) and chronic (N = 56) pain completed a battery of psychological tests. Pain and injury expectancies collectively explained 40% to 35% of the variance in work disability compared with 12% to 10% explained by the FABQ-W for the acute and chronic samples, respectively. After controlling for pain duration, depression, somatization, and current pain severity, pain expectancy alone accounted for 16% of the variance in patients in the chronic group (P < .001) and 33% of the variance in patients in the acute group (P < .001). Both pain and injury expectancies were associated equally with work disability for patients in the acute group (P < .001), but only pain expectancy accounted for variance in the chronic group (P < .001). Fear-avoidance beliefs, in the form of cognitive expectancies, may have as much influence on the duration of disability in patients with acute pain as they do in patients with chronic pain.