I am a new graduate nurse from an accredited program. One of my patients is seeing a psychologist for "fear-avoidance beliefs" (FABs). The doctor thinks the patient's back pain is caused by FABs. We didn't learn about this problem in school. What can you tell me about it?

Fear-avoidance beliefs and behavior occur when the patient avoids certain movements or activities because he or she is afraid these will cause pain. Studies show FAB is the single most important factor in predicting who will have chronic back pain.

A special questionnaire can be used to find out if a patient has FABs. It's called the Fear Avoidance Beliefs Questionnaire (FABQ). This tool has two sections: a physical activity scale and a work scale. The higher the score in either section, the more likely the patient will avoid physical or work activities.

Treatment for this problem is geared toward patient education. Patients are told to view their pain as a common problem that will get better. They are reminded that their back pain is not from a serious disease. They don't need to protect the back. Exercises are increased in frequency, intensity, and duration with this in mind.