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Who Is Afraid of Back Pain--And Does It Affect Their Recovery?

Why do some people with painful conditions recover while others go on to have chronic, disabling pain? It may have to do with patients' fear of pain and how they deal with it.

Patients' fear of pain is determined by a variety of factors, including their personality, coping skills, and history with pain and stress. Response to pain can range from confrontation to avoidance. With confrontation, patients gradually return to their regular activities after a traumatic event. This is seen as a healthy response. With avoidance, patients steer clear of activities they think will cause pain. This can lead to exaggerated notions of pain and increased disability over time.

Avoidance behavior has been linked to more disability and work loss in patients with low back pain and other painful conditions. In fact, researchers think that "fear of pain and what we do about it may be more disabling than pain itself." However, the role of "fear-avoidance beliefs"--beliefs that activities will lead to pain--has not been studied in patients with neck pain. Does fear also affect the recovery of patients with neck pain?

To find out, these authors measured pain, disability, and fear of activities in 59 patients with neck pain and 104 patients with low back pain. Patients in the neck group had generally been in pain longer; however, they had less disability than patients with low back pain. Patients with neck pain also tended to be a little younger, with an average age of 40 (versus 45 in the low back group).

Compared to patients with neck pain, patients with low back pain seemed to have more fear of physical and work activities. This was particularly true for patients getting worker's comp. For patients injured on the job, low back pain led to more fear of work activities than did neck pain.

Fear of physical activities was related to disability for both groups. For the low back group, fear of work activities was also linked to disability. This wasn't true for the neck group. It may be that patients have a greater fear of re-injury when the pain is in the low back. For patients in the neck group, amount of pain wasn't linked to disability or fear of activities the same way it was for the low back group.

Patients tended to have more fear of activities when they were getting work or auto compensation. These patients were probably injured while working or driving and may have been fearful of resuming these activities.

Men showed more fear of activities than women. Patients whose symptoms had come on quickly also had more fear of activities. To a lesser degree, patients with newer (more acute) pain were more fearful of activities than those with chronic pain.

In the case of low back pain, fear of physical and work activities seems to keep patients from full recovery. But fear of activities doesn't seem to play the same role for patients with neck pain. Researchers will have to keep looking for the "psychosocial" factors that affect patients' recovery from neck pain.

References: Steven Z. George, MS, PT, et al. A Comparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervical Spine Pain. In Spine. October 1, 2001. Vol. 26. No. 19. Pp. 2139-2145.

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