Do psychosocial factors mediate recovery in chronic low back pain patients?

The Fear Avoidance Model of Pain (FAM) posits that the interpretation of pain, rather than the pain itself, is chiefly related to the risk of chronicity. The model suggests that pain that is perceived as non-threatening is less likely to significantly disrupt daily activities and encourage more swift recovery. In contrast, pain that is interpreted as significantly dangerous can precipitate pain-related fear, catastrophizing and avoidance behaviours, which may ultimately lead to disability and chronic pain.

Treatment of chronic low back pain (CLBP) based on the FAM, whereby fear and safety behaviours are challenged through graded exposure to movements and tasks that the patient is currently avoiding, is supported by the scholarly literature. Although the FAM emphasizes change in pain-related cognitions as necessary for improvement, evidence directly linking changes in pain intensity and disability remains elusive. Nor is it clear if these changes are mediated through alterations in other cognitive factors such as fear-avoidance beliefs, pain catastrophizing or pain self-efficacy. As such, the authors have utilized data from a randomized clinical trial (RCT) examining the effect of an exposure-based treatment for CLBP, and extrapolated whether changes in pain catastrophizing, fear-avoidance beliefs and pain self-efficacy mediate changes in pain intensity and disability. 

RESEARCH REVIEW: Psychosocial Mediators of Pain Intensity & Disability in Chronic Low Back Pain

This paper was published in Pain Reports (2023)

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