Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain

Clin J Pain. 2011 Sep;27(7):567-77. doi: 10.1097/AJP.0b013e318219ab6c.


Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.

Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.

Results: Five distinct profiles were found: "low scores cluster," "high score cluster," "fear-avoidance beliefs and catastrophizing cluster," "distress only cluster," and "medium catastrophizing cluster." The "low scores cluster" and "distress only cluster" had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological "high risk cluster" and a "low risk cluster" showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.

Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

MeSH terms

  • Affective Symptoms / etiology
  • Catastrophization / etiology*
  • Cluster Analysis
  • Cross-Sectional Studies
  • Culture*
  • Disability Evaluation
  • Fear / psychology*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Musculoskeletal Pain / complications*
  • Musculoskeletal Pain / psychology*
  • Pain Measurement
  • Psychological Tests
  • Risk Factors
  • Sick Leave / statistics & numerical data
  • Surveys and Questionnaires
  • Time Factors