Elsevier

The Journal of Pain

Volume 14, Issue 2, February 2013, Pages 172-181
The Journal of Pain

Original Report
Fear of Injury Predicts Self-Reported and Behavioral Impairment in Patients With Chronic Low Back Pain

https://doi.org/10.1016/j.jpain.2012.10.014Get rights and content
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Abstract

Fear of injury has been posited as crucial in pain-related anxiety and in the development of chronic pain; however, research has only measured fear of injury indirectly through other constructs (eg, fear of illness and fear of movement). The current study tested fear of injury as an independent contributor to pain-related anxiety and impairment. Patients (n = 78; 37% women) in a work-hardening treatment program for chronic low back pain completed self-report measures of pain-related anxiety, anxiety sensitivity, fear of injury, current pain, and impairment. Behavioral measures of impairment included lifting capacity, treatment outcomes, and days absent from treatment. Structural equation modeling tested the role of fear of injury within contemporary theory. Fit for the theoretical model was excellent and superior to an alternative model. Variance accounted for in pain-related anxiety by fear of injury, anxiety sensitivity, and current pain was 64%, while pain-related anxiety and current pain predicted 49% of variance in latent impairment. Fear of injury directly predicted pain-related anxiety (β = .42) and indirectly predicted impairment through pain-related anxiety (β = .19). Fear of injury may warrant theoretical and clinical consideration as an important contributor to pain-related anxiety and impairment; however, research is needed to explore how it may be causally related with other constructs.

Perspective

Fear of injury directly predicts pain-related anxiety and indirectly predicts self-reported and behavioral impairment. Fear of injury may warrant inclusion in contemporary theories of chronic pain. Clinicians may benefit from considering the construct in interventions for chronic pain.

Key words

Fear of injury
chronic pain
fear-avoidance
pain-related anxiety
anxiety sensitivity

Cited by (0)

Supported by a Canadian Institutes of Health Research Doctoral award (FRN: 113434) to M.A.T. and by a Vanier Canada Graduate Scholarship (FRN: 113528) to M.G.F.

The authors declare no conflicts of interest.