Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability

Clin J Pain. 2006 Feb;22(2):160-6. doi: 10.1097/01.ajp.0000159582.37750.39.


Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.

Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.

Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters "medium pain-related fear" and "low risk," the majority of those classified in the clusters "pain-related fear," "pain-related fear + depressed mood," and "depressed mood" reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the "pain-related fear + depressed mood" group and 42% in the "depressed mood" group reported >10 health care visits).

Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Chronic Disease
  • Cluster Analysis
  • Culture
  • Depression / psychology
  • Disability Evaluation*
  • Fear / psychology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / epidemiology
  • Musculoskeletal Diseases / psychology
  • Pain / epidemiology
  • Pain / psychology*
  • Pain Measurement
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Reproducibility of Results
  • Sick Leave
  • Surveys and Questionnaires
  • Sweden / epidemiology