Activity Avoidance and Function in Persons with Chronic Back Pain

This study examined the relative contribution of two aspects of pain-related fear to functional disability among 133 persons with chronic pain, predominantly chronic back pain: 1) beliefs that pain represents damage or significant harm to the body and 2) beliefs that activities that cause pain should be avoided. Pain-related fear was assessed using the Tampa Scale for Kinesiophobia, Version 2 (TSK-2). Factor analysis in the present study replicated the two-factor solution found in a previous investigation, representing the two dimensions of pain-related fear noted above. Activity avoidance was significantly associated with the percent of maximum expected weight lifted from floor to waist and waist to shoulder during Progressive Isoinertial Lifting Evaluation (PILE). Fear of damage or harm to the body was only significantly related to the floor to waist lift. When controlling for demographic, physiologic, and other psychological variables, only activity avoidance continued to significantly predict performance on both lifts of the PILE. Although it has been proposed that deconditioning may mediate the relationship between activity avoidance and disability, this was not supported in the present investigation. The results highlight the importance of pain-related fear, particularly activity avoidance, in the assessment of functional activity among persons with chronic pain.