A brief primary care intervention to reduce fear of movement in chronic low back pain patients

Abstract

Fear avoidance model of chronic pain-based interventions are effective, but have not been successfully implemented into primary care. It was hypothesized that speed walking times and key measures of the fear avoidance model would improve following the brief intervention delivered in primary care. A brief primary care-based intervention (PCB) that included a single educational session, speed walking (an in vivo desensitization exposure task), and visual performance feedback was designed to reduce fear avoidance beliefs and improve function in 4 patients with chronic low back pain. A multiple baseline across subjects with a changing criterion design indicated that speed walking times improved from baseline only after the PCB intervention was delivered. Six fear avoidance model outcome measures improved from baseline to end of study and five of six outcome measures improved from end of study to follow-up. This study provides evidence for the efficacy of a brief PCB fear avoidance intervention that was successfully implemented into a busy clinic for the treatment of chronic pain.

Trajectories of Fear‐Avoidance Beliefs on Physical Activity Over Two Years in People With Rheumatoid Arthritis

“…For health professionals, it is thus important not only to assess physical function, but also to identify and challenge unhelpful negative cognitions about physical activity as potentially causing pain and injury. Since there is evidence for graded exposure treatment to reduce fear‐avoidance in long‐term back pain , future studies are motivated to evaluate its feasibility and outcome in patients with RA. In addition, the effectiveness of person‐centered, progressive resistance exercise to reduce fear‐avoidance beliefs in patients with fibromyalgia may be applicable in RA as well.…”

“…This negative appraisal leads to fear, avoidant behaviors, and hypervigilance to bodily sensations, followed by disuse, depression, and disability, which in turn maintain the pain experience, fear, and avoidance . Intervention studies indicate that it is possible to affect fear‐avoidance by use of graded exposure treatment in patients with long‐term back pain and complex regional pain syndromes . Such treatment includes patient education and systematic exposure to feared activities with gradually increasing difficulty, tailored to each patient .…”

Behavioral Therapy Approaches for the Management of Low Back Pain: An Up-To-Date Systematic Review

“…In the majority of the studies, CBT was implemented as part of an add-on multidisciplinary approach [ 13 , 14 , 18 , 26 – 29 , 37 ]. However, the effectiveness of a multidisciplinary approach incorporating CBT in reducing pain intensity compared to standard care remains controversial.…”

“…Some studies report significantly greater improvements in mean pain intensity when CBT was used [ 28 , 29 ]; however in other studies, the multidisciplinary approach had no significant impact on pain management [ 10 , 18 , 26 , 27 , 37 , 46 ]. Moreover, the multidisciplinary rehabilitation program including CBT has been found to be superior to the usual care practice alone.…”

Expanding Targets for Intervention in Later Life Pain

“…In a small study conducted in primary care, patients with chronic low back pain who received a brief intervention consisting of education and a speed walking task to overcome their fear of movement combined with feedback about their performance endorsed fewer fear-avoidance beliefs following the intervention. 16 A longitudinal study of patients with chronic pain examined the relationships between changes in pain beliefs with change in overall functioning following multidisciplinary treatment. 17 Participants whose belief in their ability to effectively control pain decreased over time were more likely to experience greater disability at a 12-month follow-up after completing treatment.…”