Helping Back Patients Overcome the Fear of Pain
"Fear of pain and what we do about it may be more disabling than the pain itself." This is a quote by a well-known doctor and researcher, Gordon Waddell. Dr. Waddell studies pain, especially back pain. His idea helps explain why some people with low back pain get better while others get worse.

Studies show that a person's fear of pain is the most important factor in how he or she responds to low back pain. Fear of pain commonly leads to avoiding physical activity. Physical therapists often treat patients with back pain. Perhaps physical therapy treatment can be used to reduce the fear and avoidance behaviors that occur in some patients.

In this study, 66 first-time back pain patients were divided into two groups. The first group got standard back care. The second group had fear-avoidance physical therapy. Before treatment started, each patient answered some questions. Pain levels, disability, and fear-avoidance beliefs were included in the questions. These same measures were looked at again one month and six months after treatment.

Standard care included reading a pamphlet with information about spine anatomy and what can go wrong. Patients were given a home program of exercises. The therapist kept a log showing how often and what exercises were done.

Fear-avoidance care also included reading a pamphlet. This booklet encouraged the patient to take an active role in rehab and recovery. Anatomy was not the focus. Back pain was presented as a common problem, not a serious disease. The patients in this group received exercises, too. However, the exercises were started slowly and gradually increased in number and intensity. They did these at home and kept a log, just like the other group.

Results from this study confirm Dr. Waddell's statement. The amount of disability patients had after one month and six months was linked to the level of fear-avoidance. Only the patients with fearful beliefs improved with the fear-avoidance physical therapy.

The authors conclude that back pain patients should be screened before treatment begins. If they show signs of fear-avoidance beliefs, then fear-avoidance treatment is advised. All other patients do just as well with standard care. Patients who don't have fear- avoidance beliefs aren't helped and may actually be hindered by the fear-avoidance treatment.
Steven Z. George, PT, PhD, et al. The Effect of a Fear Avoidance-Based Physical Therapy Intervention for Patients with Acute Low Back Pain: Results of a Randomized Clinical Trial. In Spine. December 1, 2003. Vol. 28. No. 23. pp. 2551-2560.