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I work in a small factory where back pain seems to be the norm. I notice some people hurt their back and get right back to work. Others linger and finally end up on disability. Why do some people get better and others don't?

The process of moving from acute low back pain to chronic low back pain remains a mystery. Risk factors such as age, gender, and environmental and occupational issues have all been suggested. Psychosocial factors and educational levels have also been tested as possible contributors. There doesn't seem to be one major risk factor that is present in every case. Instead, it's more likely that there are a variety of combinations that are different for each person. However, there is one model that may help describe this process. That's the fear-avoidance model. In this model, there is a cognitive-behavioral reason for why some patients with acute injury develop chronic pain (and disability) while others do not. Fear that physical activity and movement will cause pain and/or reinjury causes patients to stop moving. This reaction to pain is called kinesiophobia (fear of movement). The person by nature or by experience has come to a place of overpredicting pain and catastrophizing what could or might happen. Women seem to overpredict pain more often and at a higher level of intensity compared to men. Moving greater distances at higher speeds also creates an elevated sense of fear compared to smaller movements at lower speeds. No one is exactly sure why one person develops fear-avoidance behaviors and someone else with the same or similar injury doesn't. Researchers are actively exploring studies to find out more about this phenomenon.

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