Fears (pain, relapse, movement) (Health factor for workers with an MSD)

Interpretation of the “Fears (pain, relapse, movement)” factor

Fear of pain, relapse or movement negatively influences RTW or sickness absence duration.

Definition of the “Fears (pain, relapse, movement)” factor

Short definition: When people are faced with pain or illness, they may use various strategies in their efforts to adapt. One of these is avoidance, which refers to the adoption of a behaviour designed to delay or avoid the presence of an adverse event (e.g. pain or relapse) (Kazdin, 1980). They thus avoid all activities likely to cause pain or anxiety because of their fear of relapse or movement (Ayre et Tyson, 2001; Cook, Brawer et Vowles, 2006).

To find out more:

High fears about pain, movement, relapse or work activities negatively influences RTW in workers with an MSD (Corbiere et al., 2017; Du Bois, Szpalski et Donceel, 2009; Hagen, Svensen et Eriksen, 2005; Opsahl, Eriksen et Tveito, 2016). The fear-avoidance model is commonly used to explain how psychological factors impact the pain experience, as well as the development of chronic pain and disability (Crombez, Vlaeyen, Heuts et Lysens, 1999; Linton et Shaw, 2011; Philips, 1987). In the acute pain phase, avoidance behaviours such as rest or the use of support equipment are effective in reducing suffering caused by nociception (reaction of the sensory nervous system). However, these behaviours can persist merely due to anticipation of pain rather than in response to it, and then they become problematic (Denison, Asenlof et Lindberg, 2004; Leeuw et al., 2007). Studies have shown that avoidance behaviours contribute in a major way to chronic pain and disability (Andersen, Nielsen et Brinkmann, 2012; Philips, 1987). In fact, this maladaptive strategy reduces the anxiety in the short term, but maintains the fear, which over time results in physical and motor deconditioning, disability and depressive symptoms (Vlaeyen, J. W., de Jong, Geilen, Heuts et van Breukelen, 2002; Vlaeyen, J. W. S. et Linton, 2000). More specifically, avoidance of motor activities can have harmful long-term consequences that are both physical (loss of mobility and muscle strength) and psychological (loss of self-confidence, being deprived of positive feedback, depression, concerns about physical symptoms, etc.) (Vlaeyen, J. W. S., Kole-Snijders, Boeren et van Eek, 1995; Wertli, Rasmussen-Barr, Weiser, Bachmann et Brunner, 2014).

Andersen, M. F., Nielsen, K. M. et Brinkmann, S. (2012). Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scandinavian Journal of Work, Environment & Health 93-104.

Ayre, M. et Tyson, G. (2001). The role of self-efficacy and fear-avoidance beliefs in the prediction of disability. Australian Psychologist, 36(3), 250-253.

Cook, A. J., Brawer, P. A. et Vowles, K. E. (2006). The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling. Pain, 121(3), 195-206.

Corbiere, M., Negrini, A., Durand, M. J., St-Arnaud, L., Briand, C., Fassier, J. B., . . . Lachance, J. P. (2017). Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and Validation with Workers Suffering from a Common Mental Disorder or Musculoskeletal Disorder. J Occup Rehabil, 27(3), 329-341. doi: 10.1007/s10926-016-9661-2

Crombez, G., Vlaeyen, J. W., Heuts, P. H. et Lysens, R. (1999). Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain, 80(1-2), 329-339.

Denison, E., Asenlof, P. et Lindberg, P. (2004). Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care. Pain, 111(3), 245-252. doi: 10.1016/j.pain.2004.07.001

Du Bois, M., Szpalski, M. et Donceel, P. (2009). Patients at risk for long-term sick leave because of low back pain. Spine J, 9(5), 350-359. doi: 10.1016/j.spinee.2008.07.003

Hagen, E. M., Svensen, E. et Eriksen, H. R. (2005). Predictors and modifiers of treatment effect influencing sick leave in subacute low back pain patients. Spine (Phila Pa 1976), 30(24), 2717-2723. Tiré de

Kazdin, A. E. (1980). Acceptability of alternative treatments for deviant child behavior. Journal of Applied Behavior Analysis, 13(2), 259-273.

Leeuw, M., Goossens, M. E., Linton, S. J., Crombez, G., Boersma, K. et Vlaeyen, J. W. (2007). The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of behavioral medicine, 30(1), 77-94.

Linton, S. J. et Shaw, W. S. (2011). Impact of psychological factors in the experience of pain. Physical Therapy, 91(5), 700-711.

Opsahl, J., Eriksen, H. R. et Tveito, T. H. (2016). Do expectancies of return to work and Job satisfaction predict actual return to work in workers with long lasting LBP? BMC Musculoskeletal Disorders, 17. doi: 10.1186/s12891-016-1314-2

Philips, H. (1987). Avoidance behaviour and its role in sustaining chronic pain. Behaviour research and therapy, 25(4), 273-279.

Vlaeyen, J. W., de Jong, J., Geilen, M., Heuts, P. H. et van Breukelen, G. (2002). The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. The Clinical Journal of Pain, 18(4), 251-261.

Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Boeren, R. G. B. et van Eek, H. (1995). Fear of movement / (re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62(3), 363-372. Tiré de

Vlaeyen, J. W. S. et Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332.

Wertli, M. M., Rasmussen-Barr, E., Weiser, S., Bachmann, L. M. et Brunner, F. (2014). The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. The Spine Journal, 14(5), 816-836. e814.

Tools for measuring the “Fears (pain, relapse, movement)” factor