The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study.

Abstract

OBJECTIVE: Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients. METHODS: A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention. RESULTS: At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain. CONCLUSION: The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.