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Chiropractic Research Review

Fear-Avoidance and Cervical Spine Pain

Fear-avoidance beliefs and other psychosocial factors have been linked to the progression from acute to chronic low back pain (LBP), and may be even better predictors of the condition than physical variables.

Fear-avoidance concerns the idea that the fear of developing pain can cause disability, as would an actual source of physical injury or stress. The relationship between physical and emotional perceptions of pain becomes distorted, resulting in an exaggeration of pain perception. Patients may avoid the work environment for fear of further injury.

Fear-avoidance may be more likely to cause lumbar pain because a patient perceives the potential for pain or re-injury, especially related to work, to be greater in that region. Based on the information linking fear-avoidance with LBP, the authors of this study speculated that fear-avoidance beliefs could be related to the development of cervical spine disability.

To determine cases of fear-avoidance beliefs in cervical-spine-pain patients and compare predictability, pain intensity, and disability with patients having LBP, 163 patients (104 lumbar, 59 cervical) completed the Fear-Avoidance Behavior Questionnaire (FABQ). This questionnaire had 16 questions related to LBP; cervical-spine patients were asked to relate the answers to their condition.

Results: Fear-avoidance beliefs were much less common in cervical- spine-pain patients than LBP patients, and no major differences in types of fear-avoidance beliefs were seen between LBP and cervical patients. The researchers found significant differences in fear-avoidance beliefs by gender, symptom onset, and source of payment for care (e.g., workers compensation vs. traditional insurance). Males, patients with sudden onset of pain, and cases involving workers compensation were more likely to show fear-avoidance.

The authors conclude, "These results demonstrate that variables that are helpful in determining disability for patients with lumbar spine pain may not be helpful in determining disability for patients with cervical spine pain."

The FABQ evaluation tool was not modified to specifically address patients with cervical spine pain.

George SZ, Fritz JM, Erhard RE. A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine 2001:26(19), pp. 2139-2145.

Chiropractic Research Review

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