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Emotional Distress Predicts Disability in Low Back Pain

About 10 years ago new knowledge about low back pain (LBP) came to light. Researchers wrote about the fear of movement/reinjurymodel of chronic LBP. They discovered some people had chronic LBP because they stopped moving for fear of pain or reinjury. This concept has come to be known as fear avoidance beliefs (FAB).

In this study scientists in Norway compared FAB in acute versus chronic LBP patients. Three tests were given: FAB for work, FAB for physical activity, and a third one for emotional distress. Patients with acute LBP (lasting less than three weeks) were rechecked after four weeks. Patients with acute LBP (lasting more than three months) were rechecked after three months. Everyone was followed for one full year.

The results showed that pain at the end of 12 months was linked to FAB-work and distress for patients in both groups. Distress was the strongest predictor of pain in the acute group. FAB-physical activity showed rapid improvement in the first four weeks after acute injury. The chronic group showed no change in FAB during the entire year.

The authors conclude it looks like emotional distress is a stronger predictor of long-term pain and disability compared to FABs. They suggest that emotional distress includes overall anxiety and depression. FAB may only include anxiety related to back pain. It's possible that emotional distress and FAB are related and not really two separate factors. More study is needed to test this theory.

References: Margreth Grotle, PhD, et al. Clinical Course and Impact of Fear-Avoidance Beliefs in Low Back Pain. In Spine. April 20, 2006. Vol. 31. No. 9. Pp. 1028-1046.

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