Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial.

Abstract

OBJECTIVE:

The Fear-Avoidance Model (FAM) of chronic pain posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT's effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year.

SUBJECTS:

Participants were 204 patients with low-back pain of <16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks.

METHODS:

Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales), and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators.

RESULTS:

Early PT led to improvements in disability and pain over 3 months but not 1 year. In the single mediator model, 4-week reductions in pain catastrophizing mediated early PT's effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations.

CONCLUSIONS:

In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients' catastrophizing.

• Authors: Brittany L Sisco-Taylor, John S Magel, Molly McFadden, Tom Greene, Jincheng Shen, Julie M Fritz
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 23 Issue 6 Pg. 1127-1137 (05 30 2022) ISSN: 1526-4637 [Electronic] England
• PMID: 34613379 (Publication Type: Clinical Trial, Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

Topics

• Acute Pain
• Catastrophization
• Disability Evaluation
• Fear
• Humans
• Low Back Pain (rehabilitation)
• Physical Therapy Modalities
• Surveys and Questionnaires