Fear and Avoidance of Physical Activity Linked to Chronic Low Back Pain and Medication Use

Among adults with chronic low back pain (LBP), fear-avoidance beliefs about physical activity were associated with residence, pain, and medication use, according to results of a study published in the Journal of Pain Research.

Investigators from the University of Gondar in Ethiopia and Meenakshi Academy of Higher Education and Research in India recruited 263 adults with LBP lasting more than 3 months in 2021. Study participants were evaluated for sociodemographic characteristics and attended a face-to-face interview during which time they were assessed using the modified Fear-Avoidance Belief Questionnaire About Physical Activity (mFABQ-PA). A high fear-avoidance belief about physical activity was defined as an mFABQ-PA score greater than 15.

More than half (58.2%) of the study population had experienced LBP for more than 1 year, 48.3% had radiating leg pain, 39.5% used analgesic medications for LBP, 65.4% had a body mass index (BMI) in the normal range, 42.2% had a college degree or higher, 75.3% were employed, and 85.9% lived in an urban area.

Individuals in the subset of patients who had high fear-avoidance beliefs (n=113) were significantly older (P =.04) and had completed a lower level of education (P =.02) compared with those without high fear-avoidance beliefs. In addition, more of those with high fear-avoidance beliefs lived in an urban area (P =.01), were obese (P =.03), used analgesics (P =.02), and experienced pain during activities of daily living (P =.006).

Significant predictors for high fear-avoidance beliefs included living in an urban area (adjusted odds ratio [aOR], 2.75; 95% CI, 1.32-5.88; P =.007), analgesic use (aOR, 2.0; 95% CI, 1.19-3.37; P =.009), and pain associated with activities of daily living (aOR, 1.97; 95% CI, 1.18-3.296; P =.006).

A major limitation of this study was that the investigators did not perform an area-under-the-curve analysis to determine cut-offs for predicting fear-avoidance beliefs.

Study authors conclude, “The fear-avoidance belief was higher among the urban residents, patients under analgesic medications, and those who reported pain during the performance of activities of daily living. These findings might urge the researchers to prospectively explore the causal relationship within the fear-avoidance model and assist clinicians in choosing subgroups to use behavioral therapy and graded exposure to physical activity.”

This article originally appeared on Clinical Pain Advisor