Psychological processes underlying the development of a chronic pain problem - A prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability

被引:131
作者
Boersma, K [1 ]
Linton, SJ
机构
[1] Univ Hosp Orebro, Dept Occupat & Environm Med, S-70185 Orebro, Sweden
[2] Univ Orebro, Dept Behav Social & Legal Sci Psychol, Orebro, Sweden
关键词
musculoskeletal pain; fear and avoidance; profiles; development; chronic disability;
D O I
10.1097/01.ajp.0000159582.37750.39
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way. Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave. Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters "medium pain-related fear" and "low risk," the majority of those classified in the clusters "pain-related fear," "pain-related fear + depressed mood," and "depressed mood" reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the "pain-related fear + depressed mood" group and 42% in the "depressed mood" group reported > 10 health care visits). Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.
引用
收藏
页码:160 / 166
页数:7
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