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The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study

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Abstract

Objective: Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients. Methods: A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention. Results: At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain. Conclusion: The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.

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Correspondence to Han J. A. Samwel.

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Samwel, H.J.A., Kraaimaat, F.W., Evers, A.W.M. et al. The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study. Int. J. Behav. Med. 14, 237–241 (2007). https://doi.org/10.1007/BF03002998

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