Background Severe pain, anxiety, depression and Fear-Avoidance Belief (FAB) are widespread among patients hospitalised for acute Low Back Pain (LBP). Research shows there is strong evidence that LBP is associated with a complex combination of physical, behavioural and lifestyle factors, neuro-physiological changes, and psychological, cognitive and social factors1 and that these psychological factors impact negatively on rehabilitation. Patients hospitalised for acute LBP are vulnerable not only due to their severe pain but particularly due to their feeling of lack of control. There is a lack of knowledge of how these concerns are expressed by these patients.
Objectives This study aimed to investigate and develop an understanding of pain in patients with fear avoidance belief hospitalised for LBP.
Methods Semi-structured interviews were conducted with nine patients selected by an FAB questionnaire: averaged FAB–Physical Activity score was 21 and FAB–Work score was 30. All participants were recruited from a rheumatology ward. Analyses were based on content analysis.
Results The analysis revealed two main categories (1) “Back history until the pain got the upper hand”, covering two sub-categories “Living in spite of pain” and “When pain took over” demonstrating the importance of the LBP histories before admission to hospital. (2) “Being in a universe of pain” verified the severe pain expressed through metaphors and a need to be involved in the rehabilitation. Following sub-categories were identified: “Pain experiences”, “The ups and downs of pain treatment”, “Frustration at being hospitalised” and “Preparing to resume their lives”. During interviews the participants did not indicate high FAB behaviour.
Conclusions Despite high scores the FAB questionnaire might not be sufficient to detect FAB in patients hospitalised for acute LBP. It is important to include the deeper meaning of metaphors and the personal story behind the expression of pain as a way of understanding each individual with LBP.
FAB questionnaire might not be sufficient to detect fear avoidance in LBP patients hospitalised with acute conditions.
It seems essential to involve the patient in rehabilitation based on their individual histories and concerns about the future.
Understanding the deeper meaning of metaphors expressed about pain could be a way to gain insight of the physiological aspects of LBP.
O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. Br J Sports Med 2012;46(4):224-7.
Acknowledgements We thank the patients who participated in this study. This research was supported by a Research Grant from Glostrup Hospital, University of Copenhagen, Capital Region of Denmark. The funder had no role in the design or management of the study, data analysis or the preparation of this study.
Disclosure of Interest None declared