Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers' compensation claimants

Pain. 2011 Feb;152(2):376-383. doi: 10.1016/j.pain.2010.10.044. Epub 2010 Dec 13.


The fear avoidance model of pain (FAM) conceptualizes pain catastrophizing as the cognitive antecedent of pain-related fear, and pain-related fear as the emotional antecedent of depression and disability. The FAM is essentially one of mediation whereby pain-related fear becomes the process by which depression or disability ensue. However, emerging literature suggests that pain catastrophizing, pain-related fear, and depression might be at least partially distinct in their prediction of different pain-related outcomes. The primary purpose of the present study was to evaluate whether psychological factors in the FAM (pain catastrophizing, pain-related fear, and depression) differentially predict long-term pain-related outcomes. Toward this objective, we conducted a prospective study using a cohort of 202 individuals with subacute work-related musculoskeletal injuries. Participants completed a 7-week physical therapy program with a functional rehabilitation orientation. Posttreatment measures of fear of movement, pain catastrophizing, depression, and pain self-efficacy were used to predict the persistence of pain symptoms, healthcare use, medication use, and return-to-work at one-year follow-up. Results from hierarchical linear and logistic regression analyses revealed that pain catastrophizing and fear of movement act as differential predictors of long-term pain-related outcomes. Specifically, we found unique relationships between pain catastrophizing and long-term pain intensity, and fear of movement and long-term work disability. After controlling for pain intensity and FAM variables, pain self-efficacy was shown to be a unique predictor of medication use. Implications for the FAM and the clinical management of musculoskeletal pain conditions are discussed. Unique relationships were found between pain catastrophizing and long-term pain intensity, between fear of movement and long-term work disability, and between pain self-efficacy and medication use at one-year follow-up.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Canada / epidemiology
  • Catastrophization / economics
  • Catastrophization / epidemiology*
  • Catastrophization / rehabilitation
  • Cohort Studies
  • Depression / economics
  • Depression / epidemiology*
  • Depression / rehabilitation
  • Fear / psychology*
  • Female
  • Forecasting
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / economics
  • Musculoskeletal Diseases / epidemiology*
  • Musculoskeletal Diseases / rehabilitation
  • Pain / economics
  • Pain / epidemiology*
  • Pain / psychology*
  • Prospective Studies
  • Workers' Compensation*
  • Young Adult