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Catastrophizing, fear and avoidance in the development of chronic pain McMurtry, Bruce Wiliam

Abstract

A self-perpetuating cycle of catastrophizing, pain related fear (PRF), and avoidance following tissue stress or damage has been proposed to underlie the development of chronic pain in some individuals (Vlaeyen, Kole-Snijders, Rotteveel, et al., 1995; Vlaeyen & Linton, 2000). A number of instruments have been designed to measure aspects of PRF and catastrophizing, and research utilizing them has provided support for many aspects of the pain related fear/avoidance cycle (Vlaeyen & Linton, 2000). However, there has been relatively little research on PRF or catastrophizing early in the transition to chronic pain and disability. The current study examined the structure of PRF and catastrophizing early in the course of a low-back pain episode, and the prediction of three-month outcome from those variables. Work disabled individuals with lowback pain completed questionnaires, including measures of PRF (i.e.. Pain Anxiety Symptoms Scale (McCracken, Zayfert & Gross, 1992), Fear Avoidance Beliefs Questionnaire, (Waddell, Newton, Henderson, Somerville & Main, 1993), Tampa Scale of Kinesiophobia (Vlaeyen, Kole- Snijders, Boeren & van Eek, 1995)) and catastrophizing (Pain Catastrophizing Scale (Sullivan, Bishop & Pivik, 1995)), by mail at less than seven weeks post-pain onset and a second set of questionnaires, including measures of pain, perceived disability, depressive symptoms, and return to work at 3 months post-onset. Confirmatory factor analyses indicated that in this sample, all of the instruments except the TSK conformed to the factor structure intended by the scale designers. Structural Equation Modeling provided support for the relationships between pain level, PRF, catastrophizing and avoidance proposed by Vlaeyen and Linton to characterize fear-avoidance cycle. Regression analyses demonstrated that at least some aspects of PRF and/or catastrophizing contributed significantly to the prediction of all aspects of three-month outcome after controlling for demographics and initial pain level. These results provide support for the role of catastrophizing and PRF in the development of chronic pain and for the mechanisms proposed by Vlaeyen and Linton (2000) to underlie that effect, but suggest there may be utility further refinement of PRF measures. Limitations to the study and broader theoretical and clinical implications are discussed.

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