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Facing the Fear of Back Pain Head On

Avoid or confront? When it comes to conflict or pain, most people fall somewhere between those two extremes. Back pain patients are more likely to have chronic pain if they avoid movement that might cause them pain. This is called fear-avoidance behavior and is the topic of this case report.

A 42-year old sales manager with acute low back pain (LBP) showed signs of fear-avoidance behavior. He hurt himself when lifting a heavy suitcase into his car. An MRI showed a herniated disc at L4/5.

He was put seen by a physical therapist who gave him a special form called a Fear- Avoidance Beliefs Questionnaire. The results showed he was likely to be an avoider. This rating put him at increased risk for chronic LBP and disability. He was put on a program of exercises and given a special patient booklet called The Back Book.

After the patient read the booklet, the therapist discussed the idea of fear-avoidance with the patient. The patient went to physical therapy twice a week for three weeks. He did a home program of exercises and walking. The patient was tested for pain, disability, and fear-avoidance beliefs. These measures were taken before treatment, four weeks after treatment, and six months after starting therapy.

The results showed good improvement in all areas at the end of treatment. Six months later, fear-avoidance was still up but not as much as before therapy. It's not clear why the patient slid back into fear-avoidance behaviors.

The authors conclude that physical therapists should screen low back patients for elevated fear-avoidance beliefs. If fear-avoidance beliefs are present, then the exercise program should be changed to address this problem. This case report is an example of how such a management program can be carried out.

References: S. Z. George, PT, PhD, et al. Physical Therapist Management of a Patient with Acute Low Back Pain and Elevated Fear-Avoidance Beliefs. In Physical Therapy. June 2004. Vol. 84. No. 6. Pp. 538-549.

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