Objectives: Chronic musculoskeletal (MSK) pain is prevalent in society. It imposes a significant burden to patients. They may be forced to alter behaviour directly due to pain, but also change behaviour due to a fear of provoking pain, and avoid activities that they think might increase pain. Evidence has shown that psychosocial factors, such as Fear Avoidance Behaviour (FAB) and illness beliefs, have a higher impact on physical disability than patho-anatomical factors and pain levels [2]. Aim: to investigate the prevalence of FAB in patients with chronic MSK pain in an Irish HSE primary care setting, and associations between those FAB and self-reported illness beliefs, pain levels, physical (disability level) and mental health.
Methods: 100 self-reported anonymous questionnaires were obtained from each of 3 HSE primary care clinics in Dublin South West (n=300), using consecutive sampling. The data for the study included a patient profile questionnaire, Tampa Scale of Kinesiophobia (TSK), Visual analogue scale (VAS), SF-12 Health Survey (SF- 12) and Illness Perception Questionnaire Chronic Pain version (IPQ-CP). The data were analysed using SPSS 20.0.
Results: Descriptive statistics examined the frequencies and percentage of responses on patient profile questions, measures of central tendency and dispersion for pain levels, SF- 12 and IPQ-CP. Mann-Whitney U-test were used to examine whether there was any statistically significant difference in the pain level and quality of life between group with low TSK ≤ 37 and group with high TSK > 37.
Results indicated that patients with higher levels of FA behaviour had higher levels of chronic MSK pain. Out of 300 participates, 247 displayed high levels of kinesiophobia with associated FA behaviour. The high FA behaviour group also displayed lower levels of quality of life in regards to the physical functioning component and the mental health functioning component of the SF-12. Results indicated that there was a statistically significant difference in the pain levels (VAS) (U = 3243, p < 0.001) and quality of life levels (SF-12) (U = 3499, p < 0.001) between patients with low TSK ≤ 37 and high TSK > 37. Pain levels were higher for the group with high TSK > 37 and quality of life was lower for group with TSK >37.
Conclusion: This study’s results indicated that FA behaviour had a statistically significant association with pain levels and quality of life of participants. It identified there was a significant association between high pain levels, and both elevated FA behaviour, and low quality of life. This research found 82% of patients with chronic MSK pain were identified to have high FA behaviour. This shows that FA behaviour was highly prevalent in patients with chronic MSK pain in this Irish HSE primary care setting.
This highlights the importance of routinely assessing the level of FA behaviour that such a chronic pain patient may have, in formulating an appropriate treatment plan to match the patients' attitudes and beliefs and so contribute to improved outcome [1].
References:
[1] Turk &Wilson. Fear of Pain as a Prognostic Factor in Chronic Pain: Conceptual Models, Assessment, & Treatment Implications. Curr Pain Headache Rep. 2010 April; 14(2): 88–95.
[2] Vlaeyen J, Linton S. Fear avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012; 153(6): 1144-7.
Ethics: Granted by the UCD Human Research Ethics Committee (Sciences) and HSE DSW Primary Care Division.
