Fear and avoidance in dysfunctional chronic back pain patients

Two studies that assess fear and avoidance in patients with chronic pain are presented. In the first study, 200 patients with chronic back pain were classified, using the Multidimensional Pain Inventory (Kerns et al., 1985) clustering procedure, as dysfunctional (n = 53), interpersonally distressed (n = 37), and adaptive copers (n = 62). Groups were compared on common measures of anxiety, fear and avoidance. Multivariate analysis of variance indicated that the groups differed significantly across measures. Univariate follow-up revealed that there were no differences between groups on agoraphobic, blood/injury, social fears, or anxiety sensitivity; however, patients classified as dysfunctional reported more pain-specific fear and avoidance than did those classified as interpersonally distressed or adaptive copers. In the second study, pain-specific fear and avoidance measures were used in a discriminant function analysis to predict the MPI classification of an independent sample of 55 patients with chronic pain. The measures correctly classified 76.5% of the dysfunctional group and 71.1% of a composite group of interpersonally distressed and adaptive copers. The implications of these findings are discussed.