Pain related fear refers to an excessive and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to pain. Patients with back pain often have areas of concern which need to be managed carefully. All too often, health professionals give inadequate or conflicting advice which undermines any faith and confidence offered down the line in the patient’s management journey. Specific areas of concern may include:
- Fear of pain
- Fear of hurt and harm
- Fear of disability
- Fear of loss of control
- Fear of surgery
- Fear of effect on family and relationships
- Fear of losing employment, loss of earnings etc.
There is increasing evidence that fear of pain, and fear of hurt or harm is a fundamental mechanism in promoting low back pain and disability. It is a normal reaction in the first instance to avoid what appeared to be the cause of the pain. However, fear may lead to complete avoidance of that activity. Up to a point this would seem reasonable, but eventually misunderstandings develop into fixed beliefs about hurt and harm surrounding their back pain. For instance patients might avoid any treatment or rehabilitation where a degree of pain may be experienced. To adequately reduce these fears and anxieties, clinicians need a clear understanding of what the patient wants from the consultation. Failure to address these issues increases the chance of misunderstanding and dissatisfaction which may affect treatment and recovery. A useful analogy in breaking down this fear would be the example of an athlete recovering from injury, or unfit, who accepts pain as a natural consequence of training.