Catastrophizing and fear avoidance beliefs in chronic low back pain: a cross-sectional study

BACKGROUND: Chronic low back pain continues to be a challenge in everyday rehabilitation services as improvement keeps being unpredictable. AIM: To evaluate the role of pain coping strategies, fear-avoidance beliefs, anxiety and depression in pain and disability in patients with chronic low back pain. POPULATION: Overall, 276 patients (200 women) with nonspecific low back pain according COST-B13 guidelines and lasting more than 6 months. SETTING: Rehabilitation and Orthopedic departments in four tertiary hospitals in Spain. DESIGN: A cross sectional study. METHODS: Pain, disability, coping strategies, catastrophizing, anxiety, depression and fear-avoidance beliefs were evaluated with validated questionnaires. Predictive associations of disability and pain were analyzed by Pearson's test and by multivariate regression. RESULTS: Catastrophizing is the pain coping strategy with the highest association with disability (r=0.52, P<0.01). Low back pain and disability showed little correlation in between (r=0.40, P<0.01). The correlation between fear-avoidance ideas and pain and disability was slight (r=0.20, P<0.01). No association was found between anxiety and depression with low back pain and disability. In the regression model, catastrophizing, kinesiophobia and gender explained 35% of the variance in disability. In the subanalysis of patients with surgical indication the influence of catastrophizing was maintained. However, correlation between pain and disability is lower than in patients without surgical indication. CONCLUSIONS: The limited correlation between pain and disability suggests that pain alone cannot explain the variability of disability. Catastrophizing and kinesiophobia are predictors of the degree of disability in chronic low back pain and are cognitions potentially modifiable. CLINICAL REHABILITATION IMPACT: These results support the biopsychosocial model in the pathogenesis of chronic low back pain and support the use of cognitive behavioral therapy to modify maladaptive beliefs and attitudes as part of medical or surgical treatment in low back pain.