Importance of fear-avoidance behavior in chronic non-specific low back pain
Nagarajan, M and Nair, MR, Importance of fear-avoidance behavior in chronic non-specific low back pain, Journal of Back and Musculoskeletal Rehabilitation, 23, (2) pp. 87-95. ISSN 1053-8127 (2010) [Refereed Article]
International classification of Functioning, Disability and Health has adapted a biopsychosocial model for management of chronic low back pain patient (CLBP). The influence of psychological factors seems to be important in the transition from acute to chronic low back pain (> 3 months). In particular, pain-related fear and pain catastrophizing are believed to be important factors for disability. A number of studies have shown that pain-related fear is a strong predictor of self-reported disability in both acute and chronic low back pain. This situation has led to the dependency of clinicians on radio-diagnostic procedures for decision making, which often increases the financial burden. Research has evidenced that physicians and physical therapists, often fail to recognize psychological illnesses. The aim of this article is to describe the importance of fear avoidance behavior and to evaluate the immediate effect of cognitive behavioral therapy (CBT) during evaluation of patients with CLBP. An initial physical examination of a 24-year old female patient with CLBP, showed painful guarded movements over the lumbo-pelvic region, but the outcomes of her Fear-Avoidance Belief Questionnaire (FABQ) showed strong cues for psychological illness. Based on clinical reasoning, the patient was educated in terms of cognitive reconstruction. Interestingly after some CBT sessions, her spine guarding pattern was disappeared and that helped us to carry a more specific physical examination. After a few weekly therapeutic sessions of CBT, significant changes were seen in all outcome measures. It has been concluded that probably, by using specific biopsychosocial training, positive results in fear avoidance behavior can be achieved. Hence the psychotherapeutic management approach is considered as a useful economical tool in low back pain.
low back pain, fear avoidance behavior, physiotherapy, cognitive behavioral therapy (CBT), clinical reasoning