OVERCOMING FEAR AVOIDANCE BEHAVIORS AND KINESIOPHOBIA IN PATIENTS WITH CHRONIC LOW BACK PAIN

Anita Stanković, Olivera Žikić, Mirjana Kocić, Dragan Zlatanović, Ivona Stanković

DOI Number
https://doi.org/10.22190/FUMB220719005S
First page
019
Last page
026

Abstract


Chronic low back pain (CLBP) is a very complex medical, social and economic problem. Long duration and variability of symptoms can be frustrating for patients and lead to various psychological and behavioral changes, which can be expressed as an over-powering fear of movement and lead to avoidance behavior. The aim of this study was to highlight  the importance of individually designed exercises (IDE) and cognitive-behavioral treatment (CBT) in the treatment of patients with CLBP who have signs of fear-avoidance behavior and kinesiophobia. One hundred and thirty patients were included in a prospective randomized study. Group 1 (G1; n = 35) had a combined IDE and CBT program. Group 2 (G2; n = 35) had IDE, without CBT. Group 3 (G3; n = 30) had standard group exercises for CLBP. Group 4 (G4; n = 30) was a control, patients did not have IDE or CBT. Waddel's Fear Avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK), were used for monitoring and evaluation. Patients completed them at the beginning, at the end of the therapy, and also after 3 months. After therapy and three months later, a statistically significant reduction in symptoms in G1 and G2 was recorded, with better results in G1: FABQph = 4.77±3.83/5.51±4.02; FABQw = 2.31±3.69/2.94±4.19; TSK = 5.63±4.56/5.69 ± 4.55. (p <0.001). The combination of IDE and CBT is an effective therapy for CLBP patients with fear avoidance behaviour and kinesiophobia.


Keywords

chronic back pain, exercises, cognitive-behavioral treatment, fear of movement

Full Text:

PDF

References


Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007; 30(1):77-94. doi: 10.1007/s10865-006-9085-0

Lethem J, Slade PD, Troup JD, Bentley G. Outline of a Fear-Avoidance Model of exaggerated pain perception--I. Behav Res Ther. 1983; 21(4):401-408. doi: 10.1016/0005-7967(83)90009-8

Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52(2):157-168. doi: 10.1016/0304-3959(93)90127-B

Asmundson GJG, Parkerson HA, D’Ambrosio CA. Fear, Anxiety, Avoidance and Chronic Pain. In: Rassler KJ, Pine DS, Rothbaum BO, editors. Anxiety Disorders. New York: Oxford University Press; 2015. p. 227-240.

Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000; 85(3):317-332. doi: 10.1016/S0304-3959(99)00242-0

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. 1995; 62(3):363-372. doi: 10.1016/0304-3959(94)00279-N

Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999; 80(1-2):329-339. doi: 10.1016/s0304-3959(98)00229-2

McCracken LM, Gross RT, Sorg PJ, Edmands TA. Prediction of pain in patients with chronic low back pain: effects of inaccurate prediction and pain-related anxiety. Behav Res Ther. 1993;31(7):647-652. doi: 10.1016/0005-7967(93)90117-d

McCracken LM, Gross RT. Does anxiety affect coping with chronic pain? Clin J Pain. 1993; 9(4):253-259. doi: 10.1097/00002508-199312000-00006

Crombez G, Vervaet L, Lysens R, Baeyens F, Eelen P. Avoidance and confrontation of painful, back-straining movements in chronic back pain patients. Behav Modif. 1998; 22(1):62-77. doi: 10.1177/01454455980221004

Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine (Phila Pa 1976). 1997;22 (9):990-1001. doi: 10.1097/00007632-199705010-00011

Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, Troup JD, Rose MJ. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976). 1995; 20(4):478-484. doi: 10.1097/00007632-199502001-00012

Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002; 70(3):678-690. doi: 10.1037//0022-006x.70.3.678

Tuirk DC, Flor H. Chronic pain: A biobihevioral perspective. Gatchel RJ, Turk DC, editors. Psychosocial factors in pain: Critical perspectives. New York: Guiford Press; 1999. p. 18-34.

Jensen MP, Romano JM, Turner JA, Good AB, Wald LH. Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain. Pain. 1999; 81(1-2):95-104. doi: 10.1016/s0304-3959(99)00005-6

Stroud MW, Thorn BE, Jensen MP, Boothby JL. The relation between pain beliefs, negative thoughts, and psychosocial functioning in chronic pain patients. Pain. 2000; 84(2-3):347-352. doi: 10.1016/s0304-3959(99)00226-2

Winterowd C, Beck AT, Gruener D. Cognitive Therapy with Chronic Pain Patients. New York: Springer Publishing Company; 2003.

Otis JD. Managing Chronic Pain: A cognitive-behavioral therapy approach. New York: Oxford University Press 2007.

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2(Suppl 2):S192-300. doi: 10.1007/s00586-006-1072-1

Smeets RJEM, Vlaeyen JWS, Hidding A, Kester ADM, van der Heijden GJMG, Knottnerus AJ. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain. 2008; 134(3):263-276. doi: 10.1016/j.pain.2007.04.021

Sveinsdottir V, Eriksen HR, Reme SE. Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain. J Pain Res. 2012; 5:371-380. doi: 10.2147/JPR.S25330

Jensen IB, Bergström G, Ljungquist T, Bodin L, Nygren AL. A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender? Pain. 2001; 91(1-2):65-78. doi: 10.1016/s0304-3959(00)00420-6

Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther. 2003; 8(1):29-36. doi: 10.1054/math.2002.0484

George SZ, Beneciuk JM. Psychological predictors of recovery from low back pain: a prospective study. BMC Musculoskelet Disord. 2015; 16:49. doi: 10.1186/s12891-015-0509-2

Johnson RE, Jones GT, Wiles NJ, Chaddock C, Potter RG, Roberts C, Symmons DP, Watson PJ, Torgerson DJ, Macfarlane GJ. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2007; 32(15):1578-85. doi: 10.1097/BRS.0b013e318074f890

Vlaeyen JW, Morley S. Cognitive-behavioral treatments for chronic pain: what works for whom? Clin J Pain. 2005; 21(1):1-8. doi: 10.1097/00002508-200501000-00001

Jellema P, van der Horst HE, Vlaeyen JW, Stalman WA, Bouter LM, van der Windt DA. Predictors of outcome in patients with (sub)acute low back pain differ across treatment groups. Spine (Phila Pa 1976). 2006;31(15):1699-1705. doi: 10.1097/01.brs.0000224179.04964.aa

Burns JW, Kubilus A, Bruehl S, Harden RN, Lofland K. Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. J Consult Clin Psychol. 2003; 71(1):81-91. doi: 10.1037//0022-006x.71.1.81

Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006; 7(4):261-271. doi: 10.1016/j.jpain.2005.10.011

Spinhoven P, Ter Kuile M, Kole-Snijders AM, Hutten Mansfeld M, Den Ouden DJ, Vlaeyen JW. Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain. 2004; 8(3):211-219. doi: 10.1016/j.ejpain.2003.08.003

Sullivan MJ, Stanish WD. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin J Pain. 2003; 19(2):97-104. doi: 10.1097/00002508-200303000-00004

O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005; 10(4):242-255. doi: 10.1016/j.math.2005.07.001

Moore JE, Von Korff M, Cherkin D, Saunders K, Lorig K. A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting. Pain. 2000; 88(2):145-153. doi: 10.1016/S0304-3959(00)00314-6

Buchbinder R, Jolley D. Effects of a media campaign on back beliefs is sustained 3 years after its cessation. Spine (Phila Pa 1976). 2005; 30(11):1323-1330. doi: 10.1097/01.brs.0000164121.77862.4b

de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clin J Pain. 2005; 21(1):9-17; discussion 69-72. doi: 10.1097/00002508-200501000-00002




DOI: https://doi.org/10.22190/FUMB220719005S

Refbacks

  • There are currently no refbacks.


© University of Niš, Serbia
Creative Commons licence CC BY-NC-ND
ISSN 0354-4699 (Print)
ISSN 2406-050X (Online)