Disability in chronic low back pain

Abstract

The landmark paper discussed in this chapter, ‘Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability’, published by Crombez et al. in 1999, investigates the issue of disability in chronic low back pain and explores the role of psychological factors in disability. The paper reports on three independent chronic low back pain studies in which behavioural performance and the degree of reported disability were correlated with psychological factors such as catastrophization, negative affect, anxiety, and pain-related fear (e.g. fear of re-injury). In a counterintuitive finding, pain-related fear was more disabling that the pain itself. This paper thus highlighted the need to assess and address the psychological domains of pain; it also validated three questionnaires that are important in the pain field, and established a biopsychosocial approach to understanding, explaining, and treating chronic low back pain.