The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling.

Department of Anesthesiology, Division of Pain Management, University of Virginia Health System, Charlottesville, VA 22908, USA.
Pain (Impact Factor: 5.64). 05/2006; 121(3):195-206. DOI: 10.1016/j.pain.2005.11.018
Source: PubMed

ABSTRACT The cognitive-behavioral, fear-avoidance (FA) model of chronic pain (Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72) has found broad empirical support, but its multivariate, predictive relationships have not been uniformly validated. Applicability of the model across age groups of chronic pain patients has also not been tested. Goals of this study were to validate the predictive relationships of the multivariate FA model using structural equation modeling and to evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK), levels of pain-related fear, and fit of the FA model across three age groups: young (< or =40), middle-aged (41-54), and older (> or =55) adults. A heterogeneous sample of 469 chronic pain patients provided ratings of catastrophizing, pain-related fear, depression, perceived disability, and pain severity. Using a confirmatory approach, a 2-factor, 13-item structure of the TSK provided the best fit and was invariant across age groups. Older participants were found to have lower TSK fear scores than middle-aged participants for both factors (FA, Harm). A modified version of the Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H (Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72.) FA model provided a close fit to the data (chi(2)(29)=42.0, p>0.05, GFI=0.98, AGFI=0.97, CFI=0.99, RMSEA=0.031 (90% CI 0.000-0.050), p close fit=0.95). Multigroup analyses revealed significant differences in structural weights for older vs. middle-aged participants. For older chronic pain patients, a stronger mediating role for pain-related fear was supported. Results are consistent with a FA model of chronic pain, while indicating some important age group differences in this model and in levels of pain-related fear. Longitudinal testing of the multivariate model is recommended.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive impairment plays a role in the development and maintenance of chronic pain. Patients with painful disorders are reported to show attentional biases toward pain-related information. However, these findings are controversial and rarely has any study examined whether chronic pain patients have attentional biases to pain-related conditioned stimuli (CS). In this study, 21 patients diagnosed with trigeminal neuralgia (TN) were recruited from the neurosurgical department of a large urban general hospital. Sixteen family members and 21 pain-free volunteers were included as two separate control groups. Pain ratings, pain-related anxiety, general anxiety, and depression were measured in all subjects using questionnaires. Two dot probe tests were performed, one which used pictures of painful versus neutral faces as cues, and another that presented three types of CS as cues that predicted certain, uncertain, or no pain. Our results demonstrated that the TN patients showed attentional biases towards painful faces and the CSs that signaled uncertain pain. Moreover, the ratings of negative emotion about their pain conditions correlated significantly with the presence of attentional biases. The patients' close family members, however, displayed biases towards uncertain-pain CS. This study demonstrates that patients with chronic pain have increased attention towards pain-related information and that the fearful thinking about pain was positively correlated with this phenomenon.
    PsyCh Journal. 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous research on the fear-avoidance model (FAM) of chronic pain suggests that the personality traits of neuroticism and negative affect (NA) influence pain catastrophizing. However, the mechanisms of their influence on pain catastrophizing remain unclear. This study examined four possible models of relationships between neuroticism, NA, and pain catastrophizing within the FAM framework using structural equation modeling. A total of 401 patients with chronic musculoskeletal pain completed measures of neuroticism, NA, three core FAM components (pain catastrophizing, pain-related fear, and pain anxiety), and adjustment outcomes (pain-related disability and depression). Regression analyses refuted the possibility that neuroticism and NA moderated each other's effect on pain catastrophic thoughts (p > 0.05). Results of structural equation modeling (SEM) evidenced superior data-model fit for the collapsed models in which neuroticism and NA were two secondary traits underlying a latent construct, negative emotion (disability: comparative fit index (CFI) = 0.93; depression: CFI = 0.91). The results offer preliminary evidence that patients presenting with more neurotic symptom and heightened NA probably elicit more catastrophic thoughts about pain.
    International Journal of Behavioral Medicine 05/2014; · 2.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP). Methods We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months. Results Our results indicated a good fit for our model (χ2 = 69.59, df = 45, p < .05; RMSEA = .05; CFI = .95; WRMR = .61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes. Conclusions The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.
    Journal of Occupational Rehabilitation 05/2014; · 2.80 Impact Factor

Full-text (2 Sources)

Available from
Jun 20, 2014