The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising
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CHIROPRACTIC & MANUAL THERAPIES
RESEARCH
Open Access
The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising Bruce F Walker*, Christine D Losco, Anthony Armson, Amanda Meyer and Norman J Stomski
Abstract Background: The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors. Methods: 183 adults, aged 20–85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score. Results: There were no significant associations between pain diagram area and any of the clinical variables. Conclusion: Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.
Introduction The 2010 Global Burden of Disease study reported that musculoskeletal disorders ranked worldwide as the second leading cause of disability [1]. In considering individual conditions, the two most prevalent types of spinal pain, low back pain and neck pain, were respectively the leading, and fourth leading, source of disability-adjusted life years [1]. The extent of this problem leads to considerable socioeconomic burden in both direct medical costs and indirect costs [2]. The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors [3-6]. About 80% of people seeking care for spinal pain will have non-specific spinal pain, for which assigning diagnostic labels is not recommended, and the approach * Correspondence: [email protected] School of Health Professions, Murdoch University, Murdoch, Australia
to management depends on the clinician’s and patient’s preferences [6,7]. Psychosocial factors encompass social and sociooccupational
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