Pain-Related Fear,Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis |
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| Institution: | 2. Private Clinical Practice, Malaga, Spain.;3. Faculty of Health Sciences, Department of Nursing, University of Malaga, Malaga, Spain.;4. Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.;2. Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland;3. School of Science and Health, Western Sydney University, New South Wales, Australia;4. Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia;2. Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia;2. North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton on Tees, Cleveland, TS19 8PE, United Kingdom;3. The Scottish Centre for Evidenced-Based, Multi-professional Practice: A Joanna Briggs Institute Centre of Excellence, School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG, United Kingdom |
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| Abstract: | Pain-related fear is considered a strong psychological predictor for both chronic pain and disability. The aims of this study were to systematically review and critically appraise the concurrent association and the predictive value of pain-related fear affecting both pain intensity and disability in individuals with chronic musculoskeletal pain (MSK). PubMed, AMED, CINAHL, PsycINFO, PubPsych, and the grey literature were searched from inception to January 2019. Observational studies reporting cross-sectional and longitudinal associations between pain-related fear and pain intensity and/or disability were included. The GRADE criteria judged whether the overall quality and strength of the evidence was high or low in terms of risk of bias, inconsistency, indirectness, imprecision and publication bias. Seventy observational studies (97% cross-sectional) were included with a total sample of 15,623 individuals (63.56% females) with chronic MSK. Pain-related fear is composed of fear of pain, pain-related anxiety, and fear-avoidance beliefs. Greater levels of fear of pain, pain-related anxiety, and fear-avoidance beliefs were significantly associated with greater pain intensity and disability. However, the quality and strength of the evidence was very low owing to the imprecision of results, risk of bias, indirectness, and publication bias were common across the included studies. Despite these limitations, these findings highlight the potential role that pain-related fear may play in chronic MSK and disability. The field would benefit from research using higher quality studies and longitudinal designs.PerspectiveThis article presents promising results about the concurrent association between pain-related fear and both pain intensity and disability in individuals with chronic MSK. Nevertheless, the overall quality and strength of the evidence was very low in terms of risk of bias, indirectness, imprecision, and publication bias. Thus, the findings should be taken with caution, and further research is needed.PROSPERO: CRD42018082018 |
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