Highlights
- •Pain-related fear is associated with more pain intensity and disability.
- •Inconsistent results according to the predictive value of pain-related fear.
- •The overall quality of the evidence was very low.
Abstract
Pain-related fear is considered a strong psychological predictor for both chronic
pain and disability. The aims of this study were to systematically review and critically
appraise the concurrent association and the predictive value of pain-related fear
affecting both pain intensity and disability in individuals with chronic musculoskeletal
pain (MSK). PubMed, AMED, CINAHL, PsycINFO, PubPsych, and the grey literature were
searched from inception to January 2019. Observational studies reporting cross-sectional
and longitudinal associations between pain-related fear and pain intensity and/or
disability were included. The GRADE criteria judged whether the overall quality and
strength of the evidence was high or low in terms of risk of bias, inconsistency,
indirectness, imprecision and publication bias. Seventy observational studies (97%
cross-sectional) were included with a total sample of 15,623 individuals (63.56% females)
with chronic MSK. Pain-related fear is composed of fear of pain, pain-related anxiety,
and fear-avoidance beliefs. Greater levels of fear of pain, pain-related anxiety,
and fear-avoidance beliefs were significantly associated with greater pain intensity
and disability. However, the quality and strength of the evidence was very low owing
to the imprecision of results, risk of bias, indirectness, and publication bias were
common across the included studies. Despite these limitations, these findings highlight
the potential role that pain-related fear may play in chronic MSK and disability.
The field would benefit from research using higher quality studies and longitudinal
designs.
Perspective
This article presents promising results about the concurrent association between pain-related
fear and both pain intensity and disability in individuals with chronic MSK. Nevertheless,
the overall quality and strength of the evidence was very low in terms of risk of
bias, indirectness, imprecision, and publication bias. Thus, the findings should be
taken with caution, and further research is needed.
PROSPERO: CRD42018082018
Key Words
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Article info
Publication history
Published online: May 04, 2019
Footnotes
Javier Martinez-Calderon, a PhD student at the University of Malaga, is funded by the University of Malaga through a predoctoral grant. All authors have made a substantial scientific contribution to the study and are thoroughly familiar with the primary data. All authors have read the complete manuscript and take responsibility for its content and completeness.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
The authors have no conflicts of interest to declare.
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