Studies show that back pain sufferers go on to develop chronic pain and disability when fear-avoidance beliefs (FABs) are present. FAB refers to the idea that the patient believes activity will cause another injury and more pain. This is a negative interpretation of painful symptoms that is often in error.

In this study, researchers from France surveyed 709 doctors (general practitioners or GPs) treating patients with low back pain (LBP). The questions asked were to assess the physicians' understanding of FABs. They also surveyed 2727 patients with acute LBP to measure pain and beliefs about pain.

They found that FABs were common early on in the episode of LBP (after five days). And they observed that patients being treated by GPs who had high FABs themselves were more likely to develop chronic pain and decreased function. This study also showed that an increase in FABs is linked with higher levels of disability.

Questions on the FAB survey are divided into two sections: physical activity and work scores. The results of this study showed that patients with fears about physical activity aren't involved in sports. But since they weren't involved in sports before the back pain started, it's possible that FABs were present before they ever had back pain.

The authors conclude that patient and physician education about back pain is needed to reduce FABs. This type of education may reduce the risk of chronic disability that can occur in some patients. Since these beliefs are present either before the episode of LBP or shortly after the LBP begins, education must begin early as well. Altering physicians' FABs is equally important.

Emmanuel Coudeyre, MD, et al. Fear-Avoidance Beliefs About Back Pain in Patients with Acute LBP. In The Clinical Journal of Pain. October 2007. Vol. 23. No. 8. Pp. 720-725.