A longitudinal study on the predictive validity of the fear-avoidance model in low back pain

Pain. 2005 Sep;117(1-2):162-70. doi: 10.1016/j.pain.2005.06.002.


Recently, fear-avoidance models have been quite influential in understanding the transition from acute to chronic low back pain (LBP). Not only has pain-related fear been found to be associated with disability and increased pain severity, but also treatment focused at reducing pain-related fear has shown to successfully reduce disability levels. In spite of these developments, there is still a lack in well-designed prospective studies examining the role of pain-related fear in acute back pain. The aim of the current study was to prospectively test the assumption that pain-related fear in acute stages successfully predicts future disability. Subjects were primary care acute LBP patients consulting because of a new episode of LBP (<or=3 weeks). They completed questionnaires on background variables, fear-avoidance model variables and LBP outcome (Graded Chronic Pain Scale, GCPS) at baseline, 3, 6, and 12 months follow-up and at the end of the study. Two-hundred and twenty-two acute LBP patients were included, of whom 174 provided full follow-up information (78.4%). A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS. Of the fear-avoidance model variables, only negative affect added to this model. Our results do not really support the longitudinal validity of the fear-avoidance model, but they do feed the discussion on the role of pain-related fear in early stages of LBP.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Avoidance Learning / physiology*
  • Disability Evaluation
  • Fear*
  • Female
  • Humans
  • Interpersonal Relations
  • Longitudinal Studies
  • Low Back Pain / physiopathology*
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pain Measurement
  • Predictive Value of Tests
  • Prospective Studies
  • Regression Analysis
  • Reproducibility of Results
  • Retrospective Studies
  • Sickness Impact Profile
  • Surveys and Questionnaires