Pain-related fear ups intensity, disability in chronic musculoskeletal pain

Being more fearful of pain appears to increase its intensity and subsequent disability in people with chronic musculoskeletal pain (MSK), reports a new meta-analysis.

Accessing the databases of PubPsych, PsycINFO, CINAHL, AMED, PubMed and the grey literature, researchers identified 70 observational studies corresponding to a pooled sample of 15,623 individuals (63.56 percent female) suffering from chronic MSK. Almost all studies were cross-sectional in design. Pain-related fear was defined as fear of pain, pain-related anxiety and fear-avoidance beliefs.

Majority of the studies measured pain-related fear as fear-avoidance beliefs (74 percent); 23 percent defined it as pain-related anxiety, and only 6 percent set its definition as fear of pain. The duration of chronic MSK ranged from 3 months to 14.82 years.

Cross-sectionally, higher fear of pain was significantly associated with greater pain intensity (p<0.0005). The same was true for the link between pain-related fear and level of disability in those with chronic low back pain (p<0.001).

Pain-related anxiety was also weakly but significantly correlated with pain intensity (p<0.01), and moderately with disability (p<0.01). The same was true for fear-avoidance beliefs.

Of note, the Newcastle-Ottawa Scale found that 79 percent of the studies were at moderate risk of bias, while only 21 percent were at low risk. Selection bias (78 percent), performance bias (79 percent) and detection bias (46 percent) were also similarly prevalent. The Grading of Recommendations Assessment, Development and Evaluation criteria also found very low quality of evidence overall.

“This article presents promising results about the concurrent association between pain-related fear and both pain intensity and disability in individuals with chronic MSK,” said the researchers. “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.”