The relation between pain-related fear and disability: A meta-analysis

Emily L. Zale, Krista L. Lange, Sherecce A. Fields, Joseph W. Ditre

Research output: Contribution to journalReview article

146 Scopus citations

Abstract

Abstract Within a biopsychosocial framework, psychological factors are thought to play an important role in the onset and progression of chronic pain. The cognitive-behavioral fear-avoidance model of chronic pain suggests that pain-related fear contributes to the development and maintenance of pain-related disability. However, investigations of the relation between pain-related fear and disability have demonstrated considerable between-study variation. The main goal of the current meta-analysis was to synthesize findings of studies investigating cross-sectional associations between pain-related fear and disability in order to estimate the magnitude of this relation. We also tested potential moderators, including type of measure used, demographic characteristics, and relevant pain characteristics. Searches in PubMed and PsycINFO yielded a total of 46 independent samples (N = 9,579) that reported correlations between pain-related fear and disability among persons experiencing acute or chronic pain. Effect size estimates were generated using a random-effects model and artifact distribution method. The positive relation between pain-related fear and disability was observed to be moderate to large in magnitude, and stable across demographic and pain characteristics. Although some variability was observed across pain-related fear measures, results were largely consistent with the fear-avoidance model of chronic pain. Perspective Results of this meta-analysis indicate a robust, positive association between pain-related fear and disability, which can be classified as moderate to large in magnitude. Consistent with the fear-avoidance model of chronic pain, these findings suggest that pain-related fear may be an important target for treatments intended to reduce pain-related disability.

Original languageEnglish (US)
Pages (from-to)1019-1030
Number of pages12
JournalJournal of Pain
Volume14
Issue number10
DOIs
StatePublished - Oct 1 2013

Keywords

  • Fear of pain
  • disability
  • fear-avoidance
  • meta-analysis
  • pain

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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